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Simon L, Finoco M, Julien-Marsollier F, Happiette A, Simon AL, Ilharreborde B. Does the addition of convex uniplanar screws in hybrid constructs improve 3D surgical correction in thoracic adolescent idiopathic scoliosis posterior fusion? J Child Orthop 2024; 18:124-133. [PMID: 38567048 PMCID: PMC10984149 DOI: 10.1177/18632521231220388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/22/2023] [Indexed: 04/04/2024] Open
Abstract
Purpose Hybrid techniques using thoracic sublaminar bands have proved their efficacy in adolescent idiopathic scoliosis posterior fusion, but clinical axial correction sometimes remained disappointing. One solution found was "the frame technique" and the second alternative was the replacement of the convex sublaminar bands by periapical uniplanar screws. The goal of this study was to compare clinical and radiological outcomes of both techniques in a consecutive cohort of adolescent idiopathic scoliosis patients. Methods All patients undergoing primary posterior fusion for thoracic adolescent idiopathic scoliosis between January 2017 and March 2020 were included. Two groups were compared: Group 1 with thoracic sublaminar bands only and Group 2 with periapical uniplanar screws. All patients underwent standing stereoradiographs. The main frontal, sagittal, and axial (apical vertebra rotation) radiological parameters of interest were analyzed. Functional outcomes were assessed using the Scoliosis Research Society 30 score. Results A total of 147 adolescents were included (Group 1, n = 73 and Group 2, n = 74 patients). In the frontal plane, a greater reduction index was observed in Group 2 (68% versus 62%, p < 0.001) as well as a better apical axial correction (67.8% versus 46.6%, p = 0.03). The number of thoracoplasty performed was reduced (6.7% versus 20.5%, p = 0.02) in Group 2, with a significant decrease in the rate of mechanical complication. No significant loss of correction was observed during follow-up in any of the group. Conclusion The adjunction of convex uniplanar screws at the periapical levels improved the three-dimensional surgical correction of thoracic adolescent idiopathic scoliosis treated with hybrid constructs. Level of evidence level III, retrospective comparative study.
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Affiliation(s)
- Laurie Simon
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
- Paris Cité University, Paris, France
| | - Mikael Finoco
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
- Paris Cité University, Paris, France
| | - Florence Julien-Marsollier
- Paris Cité University, Paris, France
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Adèle Happiette
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Anne-Laure Simon
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
- Paris Cité University, Paris, France
| | - Brice Ilharreborde
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
- Paris Cité University, Paris, France
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Ilharreborde B, Simon AL, Shadi M, Kotwicki T. Is scoliosis a source of pain? J Child Orthop 2023; 17:527-534. [PMID: 38050593 PMCID: PMC10693849 DOI: 10.1177/18632521231215861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/03/2023] [Indexed: 12/06/2023] Open
Abstract
Purpose Pain in scoliosis is definitely a hot topic with growing popularity. The literature remains very controversial, with a pain prevalence ranging from 23% to 90%, but this can be explained by the great heterogeneity of the numerous series. The aim of this review was to report results from the literature regarding pain in relation to scoliosis regardless of the etiology. Methods A bibliographic search in Medline and Google database from 2003 to March 2023 was performed. Relevant literature was analyzed, summarized, and discussed based on authors' experience. A 1-year prospective series of adolescent idiopathic scoliosis patients was also included to compare with the existing literature. Results A total of 126 adolescent idiopathic scoliosis patients were included, with a mean preoperative Cobb angle of 64.5° (range, 45°-112°). Reported pain prevalence was 34.1%. Pain and no-pain groups were very different in their self-reported experience, with a very low mean visual analogue scale score of 0.5 (± 0.6) in the no pain group, while visual analogue scale averaged 5.6 (± 1.2) in the pain group (p < 0.001). No significant difference was found between groups regarding the most relevant demographic and radiological parameters. Conclusion Evidence-based literature on "scoliosis as a source of pain" remains ambiguous. There seems to be a consensus on the lack of direct relationship between deformity magnitude and back pain intensity. A comprehensive evaluation of the patient is therefore necessary before any treatment, including medical history, clinical examination, and relevant imaging for any child with scoliosis and back pain. Level of evidence Level VI.
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Affiliation(s)
- Brice Ilharreborde
- Pediatric Orthopaedic Department, CHU Robert Debré, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris Cité University, Paris, France
| | - Anne-Laure Simon
- Pediatric Orthopaedic Department, CHU Robert Debré, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris Cité University, Paris, France
| | - Milud Shadi
- Department of Spine Disorders and Paediatric Orthopaedics, University of Medical Sciences, Poznan, Poland
| | - Tomasz Kotwicki
- Department of Spine Disorders and Paediatric Orthopaedics, University of Medical Sciences, Poznan, Poland
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Jeantet RE, Simon AL, Happiette A, Ilharreborde B. Bivertebral pedicle-supralaminar autostable claw for proximal fixation of magnetic growing rods in early-onset scoliosis. Orthop Traumatol Surg Res 2023; 109:103634. [PMID: 37172643 DOI: 10.1016/j.otsr.2023.103634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 05/15/2023]
Abstract
BACKGROUND The various methods for the proximal fixation of magnetic growing rods in patients with early-onset scoliosis (EOS) are associated with high rates of mechanical complications related to material failure or proximal junctional kyphosis (PJK). The bivertebral autostable claw (BAC) has been proven reliable in adolescent idiopathic scoliosis but has not been assessed when used with magnetic growing rods. The objective of this study was to describe the operative technique and outcomes of BAC proximal fixation of magnetic growing rods in children with EOS. HYPOTHESIS The BAC provides stable and effective proximal fixation in children with early-onset scoliosis. MATERIAL AND METHODS This retrospective observational study included 24 patients who had surgery in 2015-2019 for early-onset scoliosis with magnetic growing rod implantation and BAC proximal fixation. Radiological variables were measured in the coronal and sagittal planes before surgery, during the early postoperative period (<3months) and at last follow-up (≥2years). RESULTS No neurological complications were recorded. At last follow-up, four patients had radiological PJK, including one patient with clinical PJK due to material failure. DISCUSSION BAC proximal fixation is both effective and sufficiently stable (4.2% pull-out) to withstand the forces applied during distraction sessions and daily activities in children with EOS. Moreover, the polyaxial connecting rods ensure better BAC adaptation to the local proximal kyphosis, which is often marked in this population. CONCLUSION The BAC is a reliable proximal fixation device that is well-suited to magnetic growing rod fixation in children with EOS. LEVEL OF EVIDENCE IV, retrospective observational cohort study.
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Affiliation(s)
- Rose-Elisabeth Jeantet
- Service de chirurgie infantile à orientation orthopédique, hôpital universitaire Robert-Debré, université de Paris, Assistance publique-Hôpitaux de Paris (AP-HP), 48, bouelvard Sérurier, 75019 Paris, France.
| | - Anne-Laure Simon
- Service de chirurgie infantile à orientation orthopédique, hôpital universitaire Robert-Debré, université de Paris, Assistance publique-Hôpitaux de Paris (AP-HP), 48, bouelvard Sérurier, 75019 Paris, France
| | - Adèle Happiette
- Service de chirurgie infantile à orientation orthopédique, hôpital universitaire Robert-Debré, université de Paris, Assistance publique-Hôpitaux de Paris (AP-HP), 48, bouelvard Sérurier, 75019 Paris, France
| | - Brice Ilharreborde
- Service de chirurgie infantile à orientation orthopédique, hôpital universitaire Robert-Debré, université de Paris, Assistance publique-Hôpitaux de Paris (AP-HP), 48, bouelvard Sérurier, 75019 Paris, France
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Giovanoulis V, Koutserimpas C, Vasiliadis AV, Lepidas N, Carville S, Boulcourt S, Ilharreborde B, Simon AL. Slipped Capital Femoral Epiphysis in Adolescents: Functional Outcomes and Return to Physical Activity after Surgical Treatment. Maedica (Bucur) 2023; 18:420-425. [PMID: 38023740 PMCID: PMC10674133 DOI: 10.26574/maedica.2023.18.3.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Background: Slipped capital femoral epiphysis (SCFE) represents a relatively common hip disorder in adolescents. The present retrospective study analyzes the correlation between age, severity of the slip and physeal stability and the functional outcomes, as well as the ability to return to previous physical activity (PA) of patients surgically treated with either pining in situ (PIS) or the modified Dunn (MD) procedure (anatomical reduction of the slipped epiphysis). Methods:The present research is a retrospective observational study of patients surgically treated for SCFE from 2010 to 2015. The sample was divided into two groups: those treated with PIS and those with the MD procedure. Univariate and multivariate logistic regression analyses were performed to determine the relationship between age, Loder classification (stable/unstable), as well as Southwick slip angle (severity of the slip) to return to previous PA. Furthermore, linear regression was used to investigate the association of the above predictor variables to Oxford and Harris hip scores (HHS). Results:A total of 32 patients were identified (16 treated with PIS and 16 with the MD procedure). None of the examined predictor variables (age, Southwick slip angle, Loder classification) had statistically significant effect on the ability to return to previous PA in either the in situ or Dunn group. Univariate analysis showed that higher patients' age at the time of surgery was related to worse HHS and Oxford scores in both the PIS and MD groups. Unstable hips seem to affect unfavorably the HHS. Conclusion:The present study did not reveal any relationship between the age, degree of the Southwick slip angle, the stability of the physis, and the return to PA. Exploration of additional confounding factors are warranted to better understand the physis-related impact on the functional outcomes in both groups.
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Affiliation(s)
- Vasileios Giovanoulis
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens, Greece
| | - Angelo V Vasiliadis
- Sports Trauma and Orthopaedic Department, St. Luke's Hospital, Thessaloniki, Greece
| | - Nikolaos Lepidas
- 2nd Orthopedic Department, "Panagiotis & Aglaia Kyriakou" Children Hospital, 11527 Athens, Greece
| | - Sarah Carville
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Sarah Boulcourt
- Plateforme d'Analyse de la Marche (PAM), Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Brice Ilharreborde
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Anne-Laure Simon
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
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Boulcourt S, Badel A, Pionnier R, Neder Y, Ilharreborde B, Simon AL. A gait functional classification of adolescent idiopathic scoliosis (AIS) based on spatio-temporal parameters (STP). Gait Posture 2023; 102:50-55. [PMID: 36905785 DOI: 10.1016/j.gaitpost.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 02/04/2023] [Accepted: 03/06/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Therapeutic decisions for patients with adolescent idiopathic scoliosis (AIS) are mostly based on static measurements performed on two-dimensional standing full-spine radiographs. However, the trunk plays an essential role in the human locomotion, and the functional consequences during daily activities of this specific and common spinal deformity are not factored in. RESEARCH QUESTION Does patients with AIS have specific gait patterns based on spatio-temporals parameters measurements ? METHODS 90 AIS patients (aged 10-18 years) with preoperative simplified gait analysis were retrospectively included for analysis between 2017 and 2020. Spatio-temporal parameters (STP) were measured on a 3-m baropodometric gaitway and included the measurement of 15 normalized gait parameters. A hierarchical cluster analysis was performed to identify group of patients based on the similarities of their gait patterns, and functional variables' inter-group differences were also measured. The subject distribution was calculated to identify the structural characteristics of the subjects according to their gait patterns. RESULTS Three gait patterns were identified. Cluster 1 (46%) was defined by asymmetry, Cluster 2 (16%) by instability, and Cluster 3 (36%) by variability. Each cluster was significantly different from the other ones on at least 6 different parameters (p < 0.05). Furthermore, each cluster was associated with one type of curve: Lenke 1 for Cluster 1 (57.5%), Lenke 6 for Cluster 2 (40%) and Lenke 5 for Cluster 3 (43.5%). SIGNIFICANCE Patients with severe AIS have a dynamic signature during gait identified on STP. Understanding consequences of this deformity on gait may be an interesting avenue to study the pathological mechanisms involved in their dynamic motor organization. Furthermore, these results might also be a first step to study the effectiveness of the different therapies.
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Affiliation(s)
- Sarah Boulcourt
- Plateforme d'Analyse de la Marche (PAM), Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Anne Badel
- Unité de Biologie Fonctionnelle et Adaptative (BFA), UMR 8251, CNRS, ERL 1133, Inserm, Paris, France; Université Paris Cité, Paris, France
| | - Raphaël Pionnier
- Unité Fonctionnelle d'Analyse du Mouvement (UFAM), Hôpitaux Nationaux de Saint-Maurice, Saint-Maurice, France
| | - Yamile Neder
- Plateforme d'Analyse de la Marche (PAM), Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France; Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Brice Ilharreborde
- Université Paris Cité, Paris, France; Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Anne-Laure Simon
- Plateforme d'Analyse de la Marche (PAM), Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France; Université Paris Cité, Paris, France; Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.
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Simon AL, Kassab Hassan S, Julien-Marsollier F, Happiette A, Jehanno P, Delvaque JG, Ilharreborde B. Descriptive analysis of pediatric orthopedic surgical emergencies during the COVID-19 lockdown: Single-center observational study in a pandemic red-zone area in France. Orthop Traumatol Surg Res 2023; 109:103088. [PMID: 34597824 PMCID: PMC9761103 DOI: 10.1016/j.otsr.2021.103088] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/17/2020] [Accepted: 10/23/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Lockdown involved strict confinement of children at home, radically affecting their way of life, with increased risk of domestic accidents and the temptation to step outside of the legal framework. The aim of the present study was to analyze the impact of lockdown on pediatric emergency turnover in a university reference center situated in a high-risk "red zone" and to describe specific management measures. HYPOTHESIS Pediatric emergency turnover and the corresponding lesion mechanisms were altered by lockdown. MATERIALS AND METHODS All children undergoing emergency orthopedic surgery during lockdown (group 1) were prospectively included, then retrospectively compared to series operated on during the same period in the previous 3 years. Demographic and surgical data were analyzed, and the pathway changes that were developed were detailed. RESULTS Turnover fell by a mean 33.5%, without change in indications. The most frequent lesions were wounds (54.3%), followed by fractures (34.3%) and infections (11.4%); the upper limbs were involved in 84.6% of cases. Lockdown had been infringed in 9.7% of traumas, mainly concerning fractures (55%). Postoperative management was modulated during lockdown in 34% of cases, without complications at the time of writing. DISCUSSION Pediatric emergency turnover decreased, without major change in lesion mechanisms. Accidents associated with lockdown infringement were rare (<10%), demonstrating good adaptation on the part of these children living in an urban area. The adapted care pathway was beneficial, and will no doubt continue to optimize management in future, with accelerated circuits and use of telemedicine. LEVEL OF EVIDENCE IV, comparative retro-prospective study.
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Affiliation(s)
- Anne-Laure Simon
- Service de Chirurgie Infantile à Orientation Orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique- Hôpitaux de Paris (AP-HP), Université de Paris, 48, boulevard Sérurier, 75019 Paris, France,Corresponding author
| | - Sammy Kassab Hassan
- Service de Chirurgie Infantile à Orientation Orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique- Hôpitaux de Paris (AP-HP), Université de Paris, 48, boulevard Sérurier, 75019 Paris, France
| | - Florence Julien-Marsollier
- Service d’Anesthésie-Réanimation Pédiatrique, Hôpital Universitaire Robert Debré, Assistance Publique- Hôpitaux de Paris (AP-HP), Université de Paris, 48, boulevard Sérurier, 75019 Paris, France
| | - Adèle Happiette
- Service de Chirurgie Infantile à Orientation Orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique- Hôpitaux de Paris (AP-HP), Université de Paris, 48, boulevard Sérurier, 75019 Paris, France
| | - Pascal Jehanno
- Service de Chirurgie Infantile à Orientation Orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique- Hôpitaux de Paris (AP-HP), Université de Paris, 48, boulevard Sérurier, 75019 Paris, France
| | - Jean-Gabriel Delvaque
- Service de Chirurgie Infantile à Orientation Orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique- Hôpitaux de Paris (AP-HP), Université de Paris, 48, boulevard Sérurier, 75019 Paris, France
| | - Brice Ilharreborde
- Service de Chirurgie Infantile à Orientation Orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique- Hôpitaux de Paris (AP-HP), Université de Paris, 48, boulevard Sérurier, 75019 Paris, France
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Simon AL, Kassab Hassan S, Julien-Marsollier F, Happiette A, Jehanno P, Delvaque JG, Ilharreborde B. [Descriptive analysis of pediatric orthopedic surgical emergencies during the COVID-19 lockdown: Single-center observational study in a pandemic red-zone area in France]. Revue de chirurgie orthopedique et traumatologique 2023; 109:30-35. [PMID: 34630763 PMCID: PMC8486638 DOI: 10.1016/j.rcot.2021.09.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/23/2020] [Indexed: 02/08/2023]
Abstract
Introduction Le confinement a imposé un maintien strict des enfants à domicile, modifiant considérablement leur mode de vie avec un risque accru d’accidents domestiques et la tentation de désobéir au cadre légal. L’objectif était d’analyser l’impact du confinement sur l’activité d’urgence pédiatrique dans un centre universitaire de référence situé en zone rouge, et de décrire les modes de prise en charge spécifiques. Hypothèse L’activité chirurgicale d’urgence ainsi que les mécanismes lésionnels en orthopédie pédiatrique ont été modifiés par le confinement. Matériels et méthodes Tous les enfants pris en charge au bloc opératoire pour une urgence orthopédique pendant le confinement (groupe 1) ont été inclus de façon prospective, puis comparés de manière rétrospective aux patients opérés lors des mêmes périodes les 3 années précédentes. Les données démographiques et chirurgicales ont été analysées, et les circuits spécifiques instaurés ont été décrits. Résultats Une diminution moyenne de 33,5 % de l’activité a été constatée, sans modification des motifs de prise en charge. Les lésions les plus fréquentes étaient les plaies (54,3 %), suivies des fractures (34,3 %) et des infections (11,4 %) et concernaient le membre supérieur dans 84,6 % des cas. Le cadre légal était non respecté dans 9,7 % des traumatismes et occasionnant principalement des fractures (55 %). La prise en charge postopératoire a été modifiée durant le confinement dans 34 % des cas, sans complication à ce jour. Discussion Nos résultats ont retrouvé une diminution de l’activité d’urgence pédiatrique sans modification majeure des mécanismes lésionnels. Les accidents survenant en dehors du cadre légal sont demeurés rares (<10 %), témoignant de la bonne adaptation des enfants vivant en zone urbaine. L’adaptation du parcours patient qui a été utile pendant le confinement, a été efficace, et va sans doute permettre de continuer à optimiser la prise en charge dans le futur, avec des circuits raccourcis et la télémédecine. Niveau de preuve IV ; Étude comparative rétroprospective.
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Affiliation(s)
- Anne-Laure Simon
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert-Debré, Université de Paris, AP–HP, 48, boulevard Sérurier, 75019 Paris, France,Auteur correspondant
| | - Sammy Kassab Hassan
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert-Debré, Université de Paris, AP–HP, 48, boulevard Sérurier, 75019 Paris, France
| | - Florence Julien-Marsollier
- Service d’anesthésie-réanimation pédiatrique, Hôpital Universitaire Robert-Debré, Université de Paris, AP–HP, 48, boulevard Sérurier, 75019 Paris, France
| | - Adèle Happiette
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert-Debré, Université de Paris, AP–HP, 48, boulevard Sérurier, 75019 Paris, France
| | - Pascal Jehanno
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert-Debré, Université de Paris, AP–HP, 48, boulevard Sérurier, 75019 Paris, France
| | - Jean-Gabriel Delvaque
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert-Debré, Université de Paris, AP–HP, 48, boulevard Sérurier, 75019 Paris, France
| | - Brice Ilharreborde
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert-Debré, Université de Paris, AP–HP, 48, boulevard Sérurier, 75019 Paris, France
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Duray C, Ilharreborde B, Khalifé M, Julien-Marsollier F, Simon AL, Ferrero E. Benefit - risks analysis of thoracoplasty in adolescent idiopathic scoliosis treated by sublaminar bands. Orthop Traumatol Surg Res 2022:103484. [PMID: 36435372 DOI: 10.1016/j.otsr.2022.103484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Cosmetic concerns are one of the main complaints of patients with adolescent idiopathic scoliosis (AIS). Several studies have shown a significant improvement in self-image scores after thoracoplasty. However, the effects of thoracoplasty on pulmonary function and clinical outcomes remain debated. The objective was to analyze the benefits and risks of thoracoplasty during AIS surgery using a hybrid construct with sublaminar bands. MATERIAL AND METHODS In this monocentric prospective cohort study, 68 patients with thoracic AIS were consecutively included between 2016 and 2017. All patients had low-dose 3D radiographs. Surgical correction was performed via the posterior approach, using the posteromedial translation technique with a hybrid construct (thoracic sublaminar band and lumbar pedicle screws). A thoracoplasty was proposed in cases of severe rib hump (more than 3 cm). Pulmonary function was assessed by pulmonary function tests (PFT) with forced vital capacity, forced expiratory volume in 1 second and total lung capacity). Radiographic parameters and PFT were compared between patients who had or had not had a thoracoplasty preoperatively and 2 years postoperatively. The SRS-22 score was collected at follow-up. RESULTS The average age was 15 ± 3 years. Nineteen patients (27%) had a thoracoplasty. The demographic, radiographic and respiratory data of the 2 groups were comparable preoperatively. The correction was similar between the groups on sagittal and coronal views. At 2 years, the PFTs were comparable to those performed preoperatively and no difference was found between the groups. None of the 12 patients who had a pleural effusion had it drained. The total SRS-22 score and the cosmetic subscore were higher in the thoracoplasty group (p<0.03). DISCUSSION The association of a thoracoplasty with AIS surgery improves the self-image of patients without altering the PFTs at 2 years postoperatively. Given the low morbidity of thoracoplasty, it seems reasonable to offer it to patients with severe rib hump and high cosmetic demands. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Cédric Duray
- Service de chirurgie orthopédique et du rachis, HEGP, Université de Paris, France.
| | - Brice Ilharreborde
- Service de chirurgie orthopédique infantile, Hôpital Robert Debré, Université de Paris, France
| | - Marc Khalifé
- Service de chirurgie orthopédique et du rachis, HEGP, Université de Paris, France
| | | | - Anne-Laure Simon
- Service de chirurgie orthopédique infantile, Hôpital Robert Debré, Université de Paris, France
| | - Emmanuelle Ferrero
- Service de chirurgie orthopédique et du rachis, HEGP, Université de Paris, France
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Mallet C, Meissburger V, Caseris M, Happiette A, Chinnappa J, Bonacorsi S, Simon AL, Ilharreborde B. Does the use of intrawound povidone-iodine irrigation and local vancomycin powder impact surgical site infection rate in adolescent idiopathic scoliosis surgery? Eur Spine J 2022; 31:3020-3028. [PMID: 35913622 DOI: 10.1007/s00586-022-07340-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 05/17/2022] [Accepted: 07/20/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Surgical site infection (SSI) is a major complication after adolescent idiopathic scoliosis (AIS) surgery, with an incidence ranging from 0.5 to 7%. Intraoperative wound decontamination with povidone-iodine (PVP-I) irrigation and/or vancomycin powder in adult spinal surgery has gained attention in the literature with controversial results. The aim of this study was to investigate the impact of using intrawound PVP-I irrigation and local vancomycin powder (LVP) on the incidence of early SSI in AIS surgery. METHODS All AIS patients who underwent posterior spinal fusion between October 2016 and December 2019 were retrospectively reviewed. The incidence of early SSI was reported and compared between 2 groups defined by the treating spinal surgeons' preferences: group 1-intrawound irrigation with 2L of PVP-I and application of 3 g LVP before closure and control group 2-patients that did not receive either of these measures. RESULTS Nine early cases of SSI (2.9%) were reported among the 307 AIS posterior spinal fusion patients. Incidence of SSI in group 1 (2/178 = 1.1%) was significantly lower than in group 2 (7/129 = 5.4%; p = 0.04). There were no adverse reactions to the use of PVP-I and LVP in our study. At latest follow-up, rate of surgical revision for mechanical failure with pseudarthrosis was significantly lower in group 1 (2/178 = 1.1%) than in group 2 (9/129 = 7.0%; p = 0.01). CONCLUSION Intraoperative use of intrawound PVP-I irrigation and vancomycin powder is associated with a significant reduction of early SSI after AIS spine surgery. LEVEL OF EVIDENCE IV Retrospective study.
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Affiliation(s)
- Cindy Mallet
- Pediatric Orthopedic Department, Robert Debré University Hospital, Paris Diderot University, 48 boulevard sérurier, 75019, Paris, France.
| | - Victor Meissburger
- Pediatric Orthopedic Department, Robert Debré University Hospital, Paris Diderot University, 48 boulevard sérurier, 75019, Paris, France
| | - Marion Caseris
- Pediatric Infectious Disease Department, Robert Debré University Hospital, Paris Diderot University, Paris, France
| | - Adèle Happiette
- Pediatric Orthopedic Department, Robert Debré University Hospital, Paris Diderot University, 48 boulevard sérurier, 75019, Paris, France
| | - Jason Chinnappa
- Pediatric Orthopedic Department, Robert Debré University Hospital, Paris Diderot University, 48 boulevard sérurier, 75019, Paris, France
| | - Stéphane Bonacorsi
- Microbiology Department, Robert Debré University Hospital, Paris Diderot university, Paris, France
| | - Anne-Laure Simon
- Pediatric Orthopedic Department, Robert Debré University Hospital, Paris Diderot University, 48 boulevard sérurier, 75019, Paris, France
| | - Brice Ilharreborde
- Pediatric Orthopedic Department, Robert Debré University Hospital, Paris Diderot University, 48 boulevard sérurier, 75019, Paris, France
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10
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Ould-Slimane M, Hossein Nabian M, Simon AL, Happiette A, Julien-Marsollier F, Ilharreborde B. Posterior vertebral column resection for pediatric rigid spinal deformity. Orthop Traumatol Surg Res 2022; 108:102797. [PMID: 33333284 DOI: 10.1016/j.otsr.2020.102797] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 07/09/2020] [Accepted: 07/21/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Surgery for pediatric spinal deformity may involve vertebral osteotomies in complex cases. Vertebral column resection (VCR) is the most technically demanding procedure, with the severest morbidity. It can use a double anterior and posterior approach (APVCR), though a single posterior approach (PVCR) is gaining in popularity. HYPOTHESIS PVCR provides effective correction with acceptable morbidity in children. METHOD A single-center retrospective series included spinal deformities treated by PVCR. Surgical data and global pelvic-spinal balance parameters were analyzed. RESULTS Sixteen PVCRs were performed in 13 patients, with a mean age of 14.1±2.8 years. Mean operative time was 411±54minutes. Mean preoperative rigid principal Cobb angle was 74.3°. Mean correction was 64.3% postoperatively, without significant correction loss at last follow-up. Mean blood loss was 941±221ml. The cell-saver enabled 92.3% autologous transfusions, with 53.4% homologous transfusions. Transient monoplegia and permanent psoas deficit were observed during the postoperative period. Radiologic follow-up found 4 non-unions requiring revision. CONCLUSION PVCR provided major correction of rigid spinal deformity in children. Complications mainly comprised mechanical or neurological incidents. LEVEL OF EVIDENCE IV, non-comparative cohort study.
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Affiliation(s)
- Mourad Ould-Slimane
- Department of Orthopedic Surgery, Spine Unit, Rouen University Hospital, institut Rouennais du Rachis, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France.
| | - Mohammad Hossein Nabian
- Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University, Tehran, Iran
| | - Anne-Laure Simon
- Service de chirurgie orthopédique infantile, CHU de Robert-Debré, Paris, France
| | - Adèle Happiette
- Service de chirurgie orthopédique infantile, CHU de Robert-Debré, Paris, France
| | | | - Brice Ilharreborde
- Service de chirurgie orthopédique infantile, CHU de Robert-Debré, Paris, France
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Assan BR, Simon AL, Violas P, Sales de Gauzy J, Thepaut M, Ould-Slimane M, Pesenti S, Odent T, Glorion C, Pannier S, Ilharreborde B. Surgical outcomes of spinal osteochondroma in children: A multicentre observational study. Orthop Traumatol Surg Res 2022; 108:103239. [PMID: 35150927 DOI: 10.1016/j.otsr.2022.103239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 12/20/2020] [Accepted: 01/13/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Spinal osteochondroma (or exostosis) is a rare benign tumour whose clinical manifestations are delayed due to their slow growth and location. Few studies have addressed the characteristics and the diagnostic and therapeutic peculiarities of spinal osteochondroma in children. The objective of this multicentre observational study was to assess the outcomes of a cohort of children after surgery for spinal osteochondroma. HYPOTHESIS Surgical excision of spinal osteochondroma in children is not followed by complications or recurrences. MATERIAL AND METHODS We included consecutive children who had surgery between 2010 and 2018 at any of eight participating centres to remove spinal osteochondromas. The cause, clinical manifestations, and location of the lesions were collected. The surgical outcomes were evaluated after at least 2 years' follow-up. RESULTS We identified 22 patients who had surgery to remove 26 spinal osteochondromas at a mean age of 12.8±2.6 years. Among them, 7 had a solitary osteochondroma (SO group) and 15 had hereditary multiple osteochondromas (HMO group). At diagnosis, 72% of patients had clinical signs (spinal pain, n=4; one or more lumps, n=5; and neurological manifestations, n=3). In the HMO group, the diagnosis was made during routine MRI screening for tumours involving the spinal canal. Most osteochondromas involved the cervical spine (n=13), with no difference between the two groups (p=0.9). The lamina was the most common location but 54% of the tumours were growing within the canal (92% in the HMO group). After a mean follow-up of 5.2±4.4 years, no patients had experienced any recurrences or complications related to the disease or treatment. DISCUSSION Surgical excision of spinal osteochondromas in children is effective, with no medium-term recurrences. Our results also confirm the low peri-operative morbidity, even when the canal is involved, and the absence of any effect at last follow-up on spinal alignment. All patients with neurological manifestations at diagnosis made a full recovery. LEVEL OF EVIDENCE IV, retrospective observational cohort study.
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Affiliation(s)
- Beaudelaire R Assan
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, 48, Bd Sérurier, 75019 Paris, France
| | - Anne-Laure Simon
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, 48, Bd Sérurier, 75019 Paris, France.
| | - Philippe Violas
- Service de chirurgie pédiatrique, Hôpital Universitaire de Rennes, Hôpital Sud, 16, Bd Bulgarie, 35203 Rennes Cedex 2, France
| | - Jérôme Sales de Gauzy
- Service de pédiatrie-chirurgie orthopédique, traumatologique et plastique, Hôpital Universitaire de Toulouse, Hôpital des enfants, 330, Ave de Grande Bretagne, 31059 Toulouse Cedex 9, France
| | - Matthias Thepaut
- Service de chirurgie pédiatrique, Centre Hospitalier Régional Universitaire de Brest, Hôpital Morvan, 2, Av. Foch, 29200 Brest, France
| | - Mourad Ould-Slimane
- Service de chirurgie orthopédique, Hôpital Universitaire de Rouen, Hôpital Charles Nicolle, 37, Bd Gambetta, 76000 Rouen, France
| | - Sébastien Pesenti
- Service d'Orthopédie Infantile, Hôpital Universitaire de La Timone Enfants, Assistance-Publique des Hôpitaux de Marseille (AP-HM), 264, Rue Saint Pierre, 13005 Marseille, France
| | - Thierry Odent
- Service de chirurgie orthopédique et traumatologique pédiatrique, Hôpital Universitaire Régional de Tours, Hôpital Clocheville, 49, Bd Béranger, 37044 Tours, France
| | - Christophe Glorion
- Service de chirurgie orthopédique et traumatologique pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, 149, Rue de Sèvres, 75015 Paris, France
| | - Stéphanie Pannier
- Service de chirurgie orthopédique et traumatologique pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, 149, Rue de Sèvres, 75015 Paris, France
| | - Brice Ilharreborde
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, 48, Bd Sérurier, 75019 Paris, France
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12
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Kassab Hassan S, Simon L, Campana M, Julien-Marsollier F, Simon AL, Ilharreborde B. S2-Alar-iliac screw fixation for paediatric neuromuscular scoliosis: Preliminary results after two years. Orthop Traumatol Surg Res 2022; 108:103234. [PMID: 35144011 DOI: 10.1016/j.otsr.2022.103234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Correcting pelvic obliquity is among the main goals of surgery for neuromuscular scoliosis. Spino-pelvic fixation must be stable and capable of withstanding the considerable mechanical forces applied at the lumbo-sacral junction. Selection of the best anchoring option is therefore crucial. S2-alar-iliac (S2AI) screws, which are used in adults, are less often chosen in the French paediatric spinal-surgery community. The objective of this study was to report our preliminary experience with S2AI screws used in the treatment of paediatric patients with neuromuscular scoliosis. HYPOTHESIS Pelvic anchoring by means of S2AI screws is reliable and technically feasible in non-ambulatory children with neuromuscular scoliosis. MATERIALS AND METHODS Consecutive non-ambulatory patients who underwent scoliosis surgery with S2AI screw fixation to the pelvis between 2016 and 2018 were retrospectively included. The surgical procedure consisted in either posterior spinal fusion (PSF) or magnetic growing rod (MGR) implantation. In all patients, radiographs were obtained before surgery, within 3 months after surgery, and at last follow-up; and low-dose computed tomography (CT) was performed before and after surgery. RESULTS We included 25 patients with a mean age of 13.8±4.0 years, 18 managed by PSF and 7 by MGRs. Screw diameters ranged from 7.5 to 9.5mm and all screws were at least 60mm in length. The diameters and lengths were the same on both sides in 16 (89%) patients in the PSF group and in all patients in the MGR group. At last follow-up after a mean of 35.5±3.0 months, pelvic obliquity was corrected in all 23 patients with this abnormality before surgery. Complications consisted of lateral cortical screw breakthrough in 8 (32% of screws) patients and screw malposition in 2 (8% of screws) patients. No clinically significant complications related to the fixation material were recorded. DISCUSSION The results of our study demonstrate the feasibility of S2AI screw fixation in paediatric patients with neuromuscular scoliosis. Pelvic asymmetry and dysmorphism do not contra-indicate the procedure but must be evaluated before surgery. Further work is needed to assess the potential long-term consequences on pain and growth of screw passage through the sacro-iliac joints. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Sammy Kassab Hassan
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48 Bd Sérurier, 75019 Paris, France
| | - Laurie Simon
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48 Bd Sérurier, 75019 Paris, France
| | - Matthieu Campana
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48 Bd Sérurier, 75019 Paris, France
| | - Florence Julien-Marsollier
- Service d'anesthésie - réanimation pédiatrique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48 Bd Sérurier, 75019 Paris, France
| | - Anne-Laure Simon
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48 Bd Sérurier, 75019 Paris, France.
| | - Brice Ilharreborde
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48 Bd Sérurier, 75019 Paris, France
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Luc F, Mainard N, Payen M, Bernardini I, El-Ayoubi M, Friberg A, Piccoli ND, Simon AL. Study of the latency of transcranial motor evoked potentials in spinal cord monitoring during surgery for adolescent idiopathic scoliosis. Neurophysiol Clin 2022; 52:299-311. [PMID: 35777989 DOI: 10.1016/j.neucli.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE An increase in the latency of a motor evoked potential might be as significant as a decrease in amplitude to predict a significant and clinically symptomatic neurological injury in spinal surgery for adolescent idiopathic scoliosis. The aim of the study was to investigate the impact of monitoring of latency of motor evoked potentials during spinal surgery for adolescent idiopathic scoliosis by describing intraoperative data. METHODS Preoperative recordings of 50 patients undergoing posterior spinal fusion for idiopathic scoliosis were studied. Latencies of appearance of the motor evoked potential curves on the right and left side were recorded for each group of muscles at several key moments during the procedure (basal, before the first implant, before and after corrective maneuvers). RESULTS Mean latencies were approximately the same in each muscle group on the right and the left side, before and after correction. There was no significant increase in latency during surgery. Overall results showed that the measured latency did not differ significantly between the two age groups (p=0.07). Negative correlation between height and the means of latencies was recorded in the abductor pollicis brevis and abductor digiti minimi (r=0.4; p=0.009), rectus femoris (r=0.4; p=0.01), tibialis anterior (r=0.4; p=0.007), and abductor hallucis (r=0.5; p=0.0004). No significant correlation was found between age and intraoperative parameters. CONCLUSION Intraoperative latency could be a reliable intraoperative monitoring criteria with low variability, that might be used to predict postoperative motor deficits in surgery for adolescent idiopathic scoliosis.
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Affiliation(s)
- François Luc
- Department of Pediatric Surgery, Rouen University Hospital, France.
| | - Nicolas Mainard
- Department of Pediatric Surgery, Lille University Hospital, France
| | - Mathilde Payen
- Department of Pediatric Surgery, Rouen University Hospital, France
| | | | | | - Andreas Friberg
- Department of Pediatric Surgery, Rouen University Hospital, France
| | | | - Anne-Laure Simon
- Department of Pediatric Surgery, Paris Diderot University, France
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Gounot A, Simon AL, Dizin F, Chinnappa J, Mas V, Jehanno P. Post-traumatic Radioulnar Synostosis in Distal Forearm Fractures in Children: A Report of 2 Cases. JBJS Case Connect 2022; 12:01709767-202203000-00045. [PMID: 35142724 DOI: 10.2106/jbjs.cc.21.00590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASES Two pediatric cases of post-traumatic distal radioulnar synostosis are reported, accompanied by a literature review summarizing evidence on the management of these conditions. Radioulnar synostosis is a rare complication of distal forearm fractures, which impairs upper-extremity function. The numerous surgical procedures that have been described to treat this condition in adults typically involve synostosis resection and an interposition graft to reduce recurrence. The optimal treatment in children has not been established. CONCLUSIONS Post-traumatic radioulnar synostoses are rare conditions in pediatric patients who can be successfully treated with surgical excision of the synostoses and without the use of interposition grafting.
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Affiliation(s)
- Alexandre Gounot
- CHU Robert-Debré: Hopital Universitaire Department of Orthopaedic Surgery, Paris, France
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Mallet C, Campana M, Mas V, Simon AL, Ilharreborde B. Is anterior subcapital shortening osteotomy a reliable and reproducible technique in the treatment of severe slipped capital femoral epiphysis? Orthop Traumatol Surg Res 2022; 108:103132. [PMID: 34706290 DOI: 10.1016/j.otsr.2021.103132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 06/11/2021] [Accepted: 06/19/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Proximal femoral shortening osteotomies are becoming the treatment of choice for severe slipped capital femoral epiphysis (SCFE) to reduce the risk of femoroacetabular impingement. The reported rates of complication seem reasonable, but these are single-operator series with surgeons highly experienced in this technique. The purpose of this study was to assess how surgeon experience impacted the outcomes of anterior subcapital shortening osteotomy (ASSO) in severe SCFE. HYPOTHESIS The hypothesis was that ASSO is a reproducible technique that is accessible to junior surgeons. MATERIALS AND METHODS All ASSOs performed for severe SCFE (slipangle > 40°) between 2015 and 2019 were retrospectively reviewed. All osteotomies were performed by surgeons with less than 4 years' experience (senior residents), who were trained by a senior surgeon experienced in this technique (Group 1). The incidence of femoral head avascular necrosis (AVN) and complications were analyzed and compared to a historical control cohort (Group 2). RESULTS A total of 62 SCFEs (37 unstable and 25 stable) were analyzed. Both groups had similar demographic data and SCFE characteristics. The mean operative times were statistically comparable in both groups. The rates of AVN in unstable SCFEs and in the overall series were comparable in both groups (18.9% vs. 13.3%, p=.55 and 12.9% vs. 9.7%, p=.6). These rates were comparable in the stable forms (4.0% vs. 5.4%; p=1). However, the preoperative MRI in Group 1 showed that 42.8% of unstable hips that developed AVN were already hypoperfused before surgery. The overall rate of complication showed no significant difference between the 2 groups (26% vs. 17%, p=.16). DISCUSSION Although ASSO is a technically demanding procedure, it is reliable and reproducible. The main risk factor for developing AVN remains the unstable nature of SCFE and not the surgeon's experience. It can be performed by trained junior surgeons, but not in an emergency setting, with the possibility of assistance from a more experienced surgeon. LEVEL OF EVIDENCE IV; retrospective case study.
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Affiliation(s)
- Cindy Mallet
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48, boulevard Sérurier, 75019 Paris, France.
| | - Mathieu Campana
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48, boulevard Sérurier, 75019 Paris, France
| | - Virginie Mas
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48, boulevard Sérurier, 75019 Paris, France
| | - Anne-Laure Simon
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48, boulevard Sérurier, 75019 Paris, France
| | - Brice Ilharreborde
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48, boulevard Sérurier, 75019 Paris, France
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Simon AL, Hallé A, Tanase A, Peuchmaur M, Jehanno P, Ilharreborde B. Is magnetic resonance imaging reliable for assessing osteosarcoma of the knee joint in children? Orthop Traumatol Surg Res 2021; 109:103086. [PMID: 34597827 DOI: 10.1016/j.otsr.2021.103086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/12/2020] [Accepted: 09/24/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The study of tumor extension in knee osteosarcomas is an essential diagnostic tool that helps determine the surgical approach. Magnetic resonance imaging (MRI) is the key component in this decision-making process, but the interpretation of signals can be difficult because peritumoral edema and inflammation may be mistaken for the tumor. HYPOTHESIS There is a discrepancy between MRI and histopathology findings in the assessment of joint involvement in pediatric osteosarcomas of the knee. MATERIALS AND METHODS All children who underwent an extra-articular resection for an osteosarcoma of the knee between 2007 and 2016 were included. This was indicated if there was at least one of the following MRI signs: presence of articular effusion, involvement of either the peripheral capsuloligamentous structures, central pivot or patella, or lesion abutting the articular cartilage. RESULTS Nine patients were operated on with a mean age of 13±2.7 years. There were at least two of the described signs, mainly the involvement of the peripheral capsuloligamentous structures (78%) and central pivot (56%). The histopathology confirmed that the resection margins were healthy in all cases, but the indication for extra-articular resection could have been avoided in 89% of them. DISCUSSION MRI is the current gold standard for assessing tumor extension, but the signs contraindicating the transarticular approach remain poorly defined. Joint effusion detected by clinical or radiological assessment is the least reliable one. It seems that the tumor's proximity to the articular cartilage, as long as there is no loss of continuity in the latter, or its extension into the central pivot should no longer be considered as relevant signs. The involvement of the peripheral capsuloligamentous structure remains an indication criterion because oncologic resection is otherwise impossible, and the risk of false-negative histopathologic diagnoses is higher. Other MRI sequences could better assess the true extension into the joint space. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Anne-Laure Simon
- Service de chirurgie infantile à orientation orthopédique, hôpital universitaire Robert-Debré, université de Paris, AP-HP, 48, boulevard Sérurier, 75019 Paris, France.
| | - Aurélien Hallé
- Service de chirurgie infantile à orientation orthopédique, hôpital universitaire Robert-Debré, université de Paris, AP-HP, 48, boulevard Sérurier, 75019 Paris, France
| | - Anca Tanase
- Service de radiologie pédiatrique, hôpital Robert-Debré, université de Paris, AP-HP, 48, boulevard Sérurier, 75019 Paris, France
| | - Michel Peuchmaur
- Service d'Anatomie et de Cytologie pathologiques, hôpital Robert-Debré, université de Paris, AP-HP, 48, boulevard Sérurier, 75019 Paris, France
| | - Pascal Jehanno
- Service de chirurgie infantile à orientation orthopédique, hôpital universitaire Robert-Debré, université de Paris, AP-HP, 48, boulevard Sérurier, 75019 Paris, France
| | - Brice Ilharreborde
- Service de chirurgie infantile à orientation orthopédique, hôpital universitaire Robert-Debré, université de Paris, AP-HP, 48, boulevard Sérurier, 75019 Paris, France
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Simon AL, Angelliaume A, Happiette A, Huneidi M, Julien-Marsollier F, Ilharreborde B. Halo-gravity traction followed by definitive fusion in severe early onset scoliosis: results of a trunk analysis based on biplanar 3D reconstructions. Eur Spine J 2021; 30:3540-3549. [PMID: 34490588 DOI: 10.1007/s00586-021-06986-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/23/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Definitive fusion can be considered in early onset scoliosis (EOS) around triradiate cartilage closure. Halo-gravity traction (HGT) is an old strategy that can help lengthen and balance the spine before fusion. The postoperative changes of the trunk have never been investigated to date with modern imaging. The goal of this study was to analyze the 3D radiological outcomes, and the associated pulmonary function, of a cohort of severe EOS patients treated by definitive posterior fusion prepared by HGT. METHODS All consecutive EOS patients with severe (> 85°) and stiff (flexibility < 25%) curves, treated by HGT followed by posterior fusion, were followed. 3D radiological measurements and pulmonary function were assessed. RESULTS Forty-nine EOS patients underwent fusion, with a mean follow-up of 4 years (± 1). Age at surgery averaged 13.5 years old. HGT protocol reached on average 41% of body weight. Mean preoperative 3D Cobb angle was 95° (± 10) and final correction averaged 68.4% after surgery. 3D T4T12 kyphosis was reduced after surgery (11°, p < 0.01), while the apical vertebral rotation was improved by 27.8% (p = 0.06). 3D thoracic volume increased after surgery (p = 0.02), with a 3D T1T12 height gain averaging 3.7 cm (± 2). Both parameters were significantly correlated with total lung capacity improvement. Seven complications (14.2%) were reported, and 5 patients (10.6%) underwent unplanned revision. CONCLUSION HGT is a safe and efficient strategy to prepare posterior fusion in severe EOS patients. The 3D trunk analysis demonstrated significant postoperative gains in thoracic and spinal lengths, as well as in thoracic volume. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Anne-Laure Simon
- Department of Paediatric Orthopaedics, Robert Debré hospital, AP-HP, Paris University, 48 Boulevard Sérurier, 75019, Paris, France
| | - Audrey Angelliaume
- Department of Paediatric Orthopaedics, Robert Debré hospital, AP-HP, Paris University, 48 Boulevard Sérurier, 75019, Paris, France
| | - Adèle Happiette
- Department of Paediatric Orthopaedics, Robert Debré hospital, AP-HP, Paris University, 48 Boulevard Sérurier, 75019, Paris, France
| | - Maxime Huneidi
- Department of Paediatric Orthopaedics, Robert Debré hospital, AP-HP, Paris University, 48 Boulevard Sérurier, 75019, Paris, France
| | | | - Brice Ilharreborde
- Department of Paediatric Orthopaedics, Robert Debré hospital, AP-HP, Paris University, 48 Boulevard Sérurier, 75019, Paris, France.
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18
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Souchet P, Delaby JP, Campana M, Chinnappa J, Ilharreborde B, Simon AL. The functional method: experience from the Robert Debré Hospital. Ann Transl Med 2021; 9:1098. [PMID: 34423010 PMCID: PMC8339822 DOI: 10.21037/atm-20-7727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/24/2021] [Indexed: 12/15/2022]
Abstract
Background In the 1970s a conservative treatment for clubfoot (CF) deformity based on daily physiotherapy combining specific sequences was developed: the French functional method (FFM). Over time, the FFM technique has improved and additional measures have been introduced. The aim of this study was to report mid-term and long-term results of clubfeet treated conservatively by the FFM at birth. Methods All patients consecutively treated for clubfoot by the FFM between 1993 and 2010 were prospectively included. Initial severity was assessed by the Dimeglio classification. All patients were followed up by the same treating surgeon until skeletal maturity. Final assessment was performed using the International Clubfoot Study Group evaluation system (ICFSG). Results A total of 779 feet were included. Surgery was required in 41% of cases (mean age 2.0±0.1 years). The incidence of surgery significantly decreased after the introduction of percutaneous Achilles tenotomy (PAT) in 2000 (63.4% vs. 29.6%). At latest evaluation (mean follow-up 12±0.2 years), 86% of patients had excellent or good outcomes (mean ICFSG was 1.83±0.1). Mean ankle dorsiflexion was 10° in non-idiopathic CF and 12.1° in idiopathic CF. Eleven percent of the idiopathic clubfeet exhibited decreased ankle function (0–10°). There were no cases of overcorrection into excess ankle dorsiflexion or rocker bottom foot deformities. Conclusions Current team was the funding institution of the FFM and several modifications were proposed over times to improve outcomes. Eighty-six percent of feet had excellent to good outcomes according to the ICFSG score, with minimal residual deformities (ankle dorsiflexion between 0° and 10°, calcaneal-thigh angle between 10° and 20°) or insufficient radiological correction (defined by talo-calcaneal angle between 10° and 20°) at latest follow-up.
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Affiliation(s)
- Philippe Souchet
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris University, Paris, France
| | - Jean-Pierre Delaby
- Department of Functional Rehabilitation, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris University, Paris, France
| | - Matthieu Campana
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris University, Paris, France
| | - Jason Chinnappa
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris University, Paris, France
| | - Brice Ilharreborde
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris University, Paris, France
| | - Anne-Laure Simon
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris University, Paris, France
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19
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Julien-Marsollier F, Assaker R, Michelet D, Camby M, Galland A, Marsac L, Vacher T, Simon AL, Ilharreborde B, Dahmani S. Effects of opioid-reduced anesthesia during scoliosis surgery in children: a prospective observational study. Pain Manag 2021; 11:679-687. [PMID: 34102877 DOI: 10.2217/pmt-2020-0100] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Aims: Opioid-reduced anesthesia (ORA) was suggested to decrease morphine consumption after adolescent idiopathic scoliosis (AIS) surgery and incidence of chronic pain. Materials & methods: A prospective analysis using the ORA in AIS surgery was performed. Two cohorts were compared: a control group (opioid-based anesthesia) and the ORA group. The main outcome was morphine consumption at day 1. Results: 33 patients operated for AIS using ORA were compared with 36 with opioid-based anesthesia. Morphine consumption was decreased in the ORA group (1.1 mg.kg-1 [0.2-2] vs 0.8 mg.kg-1 [0.3-2]; p = 0.02) at day 1. Persistent neuropathic pain at 1 year was decreased in the ORA group (p = 0.02). Conclusion: The ORA protocol is efficient to reduce postoperative morphine consumption in AIS surgery and preventing neuropathic pain.
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Affiliation(s)
- Florence Julien-Marsollier
- Université de Paris, Paris, France.,Department of Anesthesia & Intensive Care, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.,DMU PROTECT, Robert Debré Hospital, 48 Boulevard Sérurier 75019, Paris, France
| | - Rita Assaker
- Université de Paris, Paris, France.,Department of Anesthesia & Intensive Care, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.,DMU PROTECT, Robert Debré Hospital, 48 Boulevard Sérurier 75019, Paris, France
| | - Daphné Michelet
- Université de Paris, Paris, France.,Department of Anesthesia & Intensive Care, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.,DMU PROTECT, Robert Debré Hospital, 48 Boulevard Sérurier 75019, Paris, France
| | - Matthieu Camby
- Université de Paris, Paris, France.,Department of Anesthesia & Intensive Care, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.,DMU PROTECT, Robert Debré Hospital, 48 Boulevard Sérurier 75019, Paris, France
| | - Anne Galland
- Université de Paris, Paris, France.,Department of Anesthesia & Intensive Care, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.,DMU PROTECT, Robert Debré Hospital, 48 Boulevard Sérurier 75019, Paris, France
| | - Lucile Marsac
- Université de Paris, Paris, France.,Department of Anesthesia & Intensive Care, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.,DMU PROTECT, Robert Debré Hospital, 48 Boulevard Sérurier 75019, Paris, France
| | - Thomas Vacher
- Université de Paris, Paris, France.,Department of Anesthesia & Intensive Care, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.,DMU PROTECT, Robert Debré Hospital, 48 Boulevard Sérurier 75019, Paris, France
| | - Anne-Laure Simon
- Université de Paris, Paris, France.,Department of Orthopedic Surgery, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France
| | - Brice Ilharreborde
- Université de Paris, Paris, France.,Department of Orthopedic Surgery, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France
| | - Souhayl Dahmani
- Université de Paris, Paris, France.,Department of Anesthesia & Intensive Care, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.,DMU PROTECT, Robert Debré Hospital, 48 Boulevard Sérurier 75019, Paris, France
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20
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Assan BR, Simon AL, Adjadohoun S, Segbedji GGP, Souchet P, Metchioungbe CS, Fiogbe MA, Ilharreborde B, Gbenou AS. Guided growth vs.Tibial osteotomy at early stage of Blount disease in squelletically immature patients. J Orthop 2021; 25:140-144. [PMID: 35068774 DOI: 10.1016/j.jor.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/02/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND There are no comparative study between guided growth and tibial osteotomy in early stage of Blount disease (BD) to our knowledge. The aim of this work was to compare the results of patients treated by these two techniques. METHOD This was a retrospective, descriptive, and analytical study over a period of 5 years in including 17 children (24 Knees) with an early stage of infantile BD in two centers. Patient were classified in two groups: group 1(treated by guided growth), group 2 (treated by Tibial Osteotomy).Preoperative alignment analysis using the tibial femoral angle (HKA) and the proximal medial tibial mechanical angle (mMPTA) were compared with three measurements taken postoperatively in each of the groups. The mean variations of the angles were compared between the two groups. RESULTS Socio-demographic characteristics were similar for the two groups. Median age at surgery was 6.5 ± 2.5 [3-9 years] in group 1 and 6.8 ± 2.9 years [3-9 years]. At a follow-up of 24 ± 3.5 months, the limb alignment was significantly corrected (1,03°/month) in group 1 (median HKA 144°-171°; p = 0,001; median MMPTA 78°-87°, p = 0,018), and in group 2 we observed at a follow-up of 23 ± 15 months a progressive loss (0,52°/month) of the correction obtained immediately postoperatively (median HKA 160°-176°(immediate post operative) to 165,5°; p = 0,31; median MMPTA = 78°-86° (immediate post operative) to 80,5°; p = 0,37).There was a statistically significant difference between the mean variation in HKA between the two groups (group 1 = 22,5; group 2 = 4,5, p = 0.00), as well as for MMPTA; (group 1 = 7; group 2 = 2,5, p = 0,023).The rate of correction was 78% in group 1 with no rebound at a median follow-up after removal of the material of 10 ± 2.4 months. Within group 2, the rate of correction was 10% with a recurrence rate of 60%. CONCLUSION Guided growth appears to be the best treatment for early stage of BD in squelletically immature patients.
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Affiliation(s)
| | - Anne-Laure Simon
- Department of Pediatric Orthopedics, Robert Debre Hospital, Paris, France
| | - Sonia Adjadohoun
- Department of Medical Imaging, National Teaching Hospital Center Hubert Koutoukou MAGA, Cotonou, Benin
| | | | - Philippe Souchet
- Department of Pediatric Orthopedics, Robert Debre Hospital, Paris, France
| | - Codjo Serge Metchioungbe
- Department of Pediatric Surgery, National Teaching Hospital Hubert Koutoukou MAGA, Cotonou, Benin
| | - Michel Armand Fiogbe
- Department of Pediatric Surgery, National Teaching Hospital Hubert Koutoukou MAGA, Cotonou, Benin
| | - Brice Ilharreborde
- Department of Pediatric Orthopedics, Robert Debre Hospital, Paris, France
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21
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Julien-Marsollier F, Michelet D, Assaker R, Doval A, Louisy S, Madre C, Simon AL, Ilharreborde B, Brasher C, Dahmani S. Enhanced recovery after surgery: Many ways for the same destination. Paediatr Anaesth 2021; 31:375-376. [PMID: 33631036 DOI: 10.1111/pan.14115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/19/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Florence Julien-Marsollier
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Daphné Michelet
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Rita Assaker
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Antoine Doval
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Simon Louisy
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
| | | | - Anne-Laure Simon
- Department of orthopaedic surgery. Robert Debré Hospital, Paris, France
| | | | - Christopher Brasher
- Department of Anaesthesia & Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia.,Anaesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Centre for Integrated Critical Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Souhayl Dahmani
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
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22
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Thomas M, Bonacorsi S, Simon AL, Mallet C, Lorrot M, Faye A, Dingulu G, Caseris M, Boneca IG, Aupiais C, Meinzer U. Acute monoarthritis in young children: comparing the characteristics of patients with juvenile idiopathic arthritis versus septic and undifferentiated arthritis. Sci Rep 2021; 11:3422. [PMID: 33564018 PMCID: PMC7873238 DOI: 10.1038/s41598-021-82553-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 01/12/2021] [Indexed: 11/17/2022] Open
Abstract
Acute arthritis is a common cause of consultation in pediatric emergency wards. Arthritis can be caused by juvenile idiopathic arthritis (JIA), septic (SA) or remain undetermined (UA). In young children, SA is mainly caused by Kingella kingae (KK), a hard to grow bacteria leading generally to a mild clinical and biological form of SA. An early accurate diagnosis between KK-SA and early-onset JIA is essential to provide appropriate treatment and follow-up. The aim of this work was to compare clinical and biological characteristics, length of hospital stays, duration of intravenous (IV) antibiotics exposure and use of invasive surgical management of patients under 6 years of age hospitalized for acute monoarthritis with a final diagnosis of JIA, SA or UA. We retrospectively analyzed data from < 6-year-old children, hospitalized at a French tertiary center for acute mono-arthritis, who underwent a joint aspiration. Non-parametric tests were performed to compare children with JIA, SA or UA. Bonferroni correction for multiple comparisons was applied with threshold for significance at 0.025. Among the 196 included patients, 110 (56.1%) had SA, 20 (10.2%) had JIA and 66 (33.7%) had UA. Patients with JIA were older when compared to SA (2.7 years [1.8–3.6] versus 1.4 [1.1–2.1], p < 0.001). Presence of fever was not different between JIA and SA or UA. White blood cells in serum were lower in JIA (11.2 × 109/L [10–13.6]) when compared to SA (13.2 × 109/L [11–16.6]), p = 0.01. In synovial fluid leucocytes were higher in SA 105.5 × 103 cells/mm3 [46–211] compared to JIA and UA (42 × 103 cells/mm3 [6.4–59.2] and 7.29 × 103 cells/mm3 [2.1–72] respectively), p < 0.001. Intravenous antibiotics were administered to 95% of children with JIA, 100% of patients with SA, and 95.4% of UA. Arthrotomy-lavage was performed in 66.7% of patients with JIA, 79.6% of patients with SA, and 71.1% of patients with UA. In children less than 6 years of age with acute mono-arthritis, the clinical and biological parameters currently used do not reliably differentiate between JIA, AS and UA. JIA subgroups that present a diagnostic problem at the onset of monoarthritis before the age of 6 years, are oligoarticular JIA and systemic JIA with hip arthritis. The development of new biomarkers will be required to distinguish JIA and AS caused by Kingellakingae in these patients.
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Affiliation(s)
- Marion Thomas
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases RAISE, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, 75019, Paris, France.,Institut Pasteur, Biology and Genetics of Bacterial Cell Wall Unit, Paris, France.,CNRS UMR2001, Paris, France.,INSERM, Equipe Avenir, Paris, France
| | - Stephane Bonacorsi
- Université de Paris, Paris, France.,Department of Microbiology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne-Laure Simon
- Université de Paris, Paris, France.,Pediatric Orthopedic Department, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cindy Mallet
- Université de Paris, Paris, France.,Pediatric Orthopedic Department, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mathie Lorrot
- Pediatric Department, Division of Infectious Diseases, Armand Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Albert Faye
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases RAISE, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, 75019, Paris, France.,Université de Paris, Paris, France
| | - Glory Dingulu
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases RAISE, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, 75019, Paris, France
| | - Marion Caseris
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases RAISE, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, 75019, Paris, France
| | - Ivo Gomperts Boneca
- Institut Pasteur, Biology and Genetics of Bacterial Cell Wall Unit, Paris, France.,CNRS UMR2001, Paris, France.,INSERM, Equipe Avenir, Paris, France
| | - Camille Aupiais
- Pediatric Emergency Department, Jean Verdier Hospital, Assistance Publique-Hôpitaux de Paris, Paris 13 University, Bondy, France.,INSERM, U1138, Equipe 22, Centre de Recherche des Cordeliers, Paris, France
| | - Ulrich Meinzer
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases RAISE, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, 75019, Paris, France. .,Institut Pasteur, Biology and Genetics of Bacterial Cell Wall Unit, Paris, France. .,CNRS UMR2001, Paris, France. .,INSERM, Equipe Avenir, Paris, France. .,Université de Paris, Paris, France. .,Centre de Recherche sur l'inflammation, UMR1149 INSERM et Université de Paris, Paris, France.
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23
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Julien-Marsollier F, Michelet D, Assaker R, Doval A, Louisy S, Madre C, Simon AL, Ilharreborde B, Brasher C, Dahmani S. Enhanced recovery after surgical correction of adolescent idiopathic scoliosis. Paediatr Anaesth 2020; 30:1068-1076. [PMID: 32750176 DOI: 10.1111/pan.13988] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/08/2020] [Accepted: 07/19/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Few publications in the literature examine enhanced recovery after scoliosis surgery (ERAS) in children, despite significant scientific interest in adults. The objective of the current study was to describe an ERAS protocol for surgical correction of adolescent idiopathic scoliosis (AIS) and its results. METHODS ERAS outcomes were measured in two patient cohorts. Historical controls and ERAS groups were selected from patients managed for scoliosis surgery in 2015 and 2018, respectively. The ERAS protocol included fasting minimization, carbohydrate loading, the avoidance of background morphine infusions, perioperative opioid-sparing protocols, the use of a cooling brace, early physiotherapy, feeding and oral medications, and the early removal of urinary catheters and surgical drains. The main outcome of the study was hospital length of stay. RESULTS Overall, 82 controls and 81 ERAS patients were recruited. ERAS protocols were observed in over 80% of patients for almost items. Median length of hospital stay was significantly lower in the ERAS group (- 3 [95% confidence interval: -2; -4] days). Median morphine consumption was reduced by 25% and 35% on days 2 and 3, respectively. The incidence of PONV did not differ between the two groups, and the incidence of constipation decreased slightly but significantly in the ERAS group on day 2. Pain intensity at rest and movement were lower in the ERAS group at day 2 and 3. CONCLUSIONS The current study suggests an ERAS protocol after adolescent idiopathic scoliosis surgery is associated with reduced hospital length of stay and improved postoperative care.
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Affiliation(s)
- Florence Julien-Marsollier
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Daphné Michelet
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Rita Assaker
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Antoine Doval
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Simon Louisy
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
| | | | - Anne-Laure Simon
- Department of Orthopaedic Surgery, Robert Debré Hospital, Paris, France
| | | | - Christopher Brasher
- Department of Anaesthesia & Pain Management, Royal Children's Hospital, Melbourne, Vic., Australia.,Anaesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Centre for Integrated Critical Care, University of Melbourne, Melbourne, Vic., Australia
| | - Souhayl Dahmani
- Department of Anesthesia and Intensive Care, Robert Debré Hospital, Paris, France.,Université de Paris, Paris, France.,DHU PROTECT, Robert Debré Hospital, Paris, France
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24
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Hasani Satehi S, Besharatry S, Simon AL, Baghdadi S, Baghdadi MT, Nabian MH. Legg–Calvé–Perthes Disease: A Case-based Resident’s Guide for the Pediatric Rotation. jost 2020. [DOI: 10.18502/jost.v5i3.4288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The article's abstract is not available.
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25
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Caseris M, Ilharreborde B, Doit C, Simon AL, Vitoux C, Poey N, Bonacorsi S, Mallet C. Correction to: Is Cutibacterium acnes early surgical site infection rate related to the duration of antibiotic prophylaxis in adolescent idiopathic scoliosis surgery? Eur Spine J 2020; 29:2106. [PMID: 32562078 DOI: 10.1007/s00586-020-06497-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Unfortunately, the authors first name and family name were incorrectly swapped in the original publication. The complete correct names of the author group is given below.
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Affiliation(s)
- Marion Caseris
- Pediatric Infectious Disease Department, Robert Debré University Hospital, Paris Diderot University, Paris, France
| | - Brice Ilharreborde
- Pediatric Orthopedic Department, Robert Debré University Hospital, Paris Diderot University, 48 Boulevard sérurier, 75019, Paris, France
| | - Catherine Doit
- Microbiology Department, Robert Debré University Hospital, Paris Diderot University, Paris, France
| | - Anne-Laure Simon
- Pediatric Orthopedic Department, Robert Debré University Hospital, Paris Diderot University, 48 Boulevard sérurier, 75019, Paris, France
| | - Christine Vitoux
- Pediatric Orthopedic Department, Robert Debré University Hospital, Paris Diderot University, 48 Boulevard sérurier, 75019, Paris, France
| | - Nora Poey
- Pediatric Infectious Disease Department, Robert Debré University Hospital, Paris Diderot University, Paris, France
| | - Stéphane Bonacorsi
- Microbiology Department, Robert Debré University Hospital, Paris Diderot University, Paris, France
| | - Cindy Mallet
- Pediatric Orthopedic Department, Robert Debré University Hospital, Paris Diderot University, 48 Boulevard sérurier, 75019, Paris, France.
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26
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Caseris M, Ilharreborde B, Doit C, Simon AL, Vitoux C, Poey N, Bonacorsi S, Mallet C. Is Cutibacterium acnes early surgical site infection rate related to the duration of antibiotic prophylaxis in adolescent idiopathic scoliosis surgery? Eur Spine J 2020; 29:1499-1504. [PMID: 32342283 DOI: 10.1007/s00586-020-06427-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 04/01/2020] [Accepted: 04/15/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Cutibacterium acnes (C. acnes) is a gram-positive anaerobic bacillus located in pilosebaceous glands, usually responsible for late postoperative surgical site infections (SSI). A recent study performed in our institution highlighted an unexpected emergence of C. acnes early SSI. One potential explanation was the change of the perioperative antibioprophylaxis (ATB) protocol, which switched from 48 h postoperative cefamandole to intraoperative only cefazoline. The aim of this study was therefore to investigate the influence of the ATB duration on the occurrence of C. acnes early SSI, by comparing the incidence rates during 3 consecutive ATB protocols. METHODS Between January 2007 and September 2017, all patients who underwent posterior fusion for AIS were retrospectively reviewed. Early C. acnes SSI were reported and compared between 3 periods, during which the ATB protocols were modified. January 2007-February 2012: Intraoperative Cefamandole continued 48 h (protocol 1) March 2012-August 2016: Single shot of intraoperative Cefazoline (protocol 2) September 2016-September 2017: Intraoperative Cefazoline continued 48 h (protocol 3). RESULTS Fifty-three early SSI (7.2%) were reported among the 732 posterior AIS fusions included. Global incidence of C. acnes infection was 2.9%. The incidence of C. acnes in early SSI increased from 0 to 4.9% between protocol 1 and 2, but was reduced to 1.7% with protocol 3. CONCLUSIONS Early C acnes SSI can be explained by the difficulty to eradicate this pathogen with current skin preparation procedures and some Beta-lactam antibiotics tolerance. Longer duration antibioprophylaxis is preferable to prevent from early C. acnes SSI.
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Affiliation(s)
- Marion Caseris
- Pediatric Infectious Disease Department, Robert Debré University Hospital, Paris Diderot University, Paris, France
| | - Brice Ilharreborde
- Pediatric Orthopedic Department, Robert Debré University Hospital, Paris Diderot University, 48 Boulevard sérurier, 75019, Paris, France
| | - Catherine Doit
- Microbiology Department, Robert Debré University Hospital, Paris Diderot University, Paris, France
| | - Anne-Laure Simon
- Pediatric Orthopedic Department, Robert Debré University Hospital, Paris Diderot University, 48 Boulevard sérurier, 75019, Paris, France
| | - Christine Vitoux
- Pediatric Orthopedic Department, Robert Debré University Hospital, Paris Diderot University, 48 Boulevard sérurier, 75019, Paris, France
| | - Nora Poey
- Pediatric Infectious Disease Department, Robert Debré University Hospital, Paris Diderot University, Paris, France
| | - Stéphane Bonacorsi
- Microbiology Department, Robert Debré University Hospital, Paris Diderot University, Paris, France
| | - Cindy Mallet
- Pediatric Orthopedic Department, Robert Debré University Hospital, Paris Diderot University, 48 Boulevard sérurier, 75019, Paris, France.
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Abstract
PURPOSE Spinal sagittal alignment restoration has been associated with improved functional outcomes and with reduced complications rates. Several limitations exist for radiological analysis in cerebral palsy (CP) patients. The goal of this study was to summarize the existing literature and report the important considerations to evaluate in a CP patient undergoing spinal surgery. METHODS A retrospective radiological analysis was performed, including non-ambulant CP children with progressive scoliosis. Full-spine sitting radiographs performed pre-and postoperatively were required to measure spino-pelvic sagittal parameters. RESULT A total of 23 non-ambulating CP patients were included, mean age 16.0 years (standard error of the mean 0.5). Two distinct groups of patients were identified. Group 1 (61%) were patients with less trunk control (lumbar lordosis (LL) < 50°), retroverted and vertical pelvis (mean sacral slope (SS) 11.4° and pelvic tilt (PT) 38.1°) and anterior imbalance (mean sagittal vertical axis (SVA) 5.9 cm) and Group 2 (39%) were patients with better trunk control (LL > 60°, anteverted and horizontal pelvis (mean SS 49.3°, PT 9.7°) and posterior imbalance (mean SVA 5.8 cm). Postoperative measures showed significant impact of surgery with a PT reduction of 19° (p = 0.007), a mean SS increase of 15° (p = 0.04) and a LL gained of 10° (p = 0.2). CONCLUSION Sagittal spino-pelvic alignment in non-ambulating CP patients remains difficult to assess. The current literature is poor but our radiological study was able to define two distinct groups among Gross Motor Function Classification System (GMFCS) level V patients, based on the quality of their trunk control. All possible factors that may influence head and trunk posture should be systematically considered and optimized. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | | | - Ana Presedo
- Department of Pediatric Orthopaedics, Paris Diderot University, France
| | - Anne-Laure Simon
- Department of Pediatric Orthopaedics, Paris Diderot University, France,Correspondence should be sent to Anne Laure Simon, Department of Pediatric Orthopaedics, Robert Debré Hospital, AP-HP, Paris Diderot University, 48 Bd Sérurier, 75019 Paris, France. E-mail:
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Tournemine S, Angelliaume A, Simon AL, Ilharreborde B. Are postoperative standing radiographs relevant before hospital discharge in adolescent idiopathic scoliosis? Eur Spine J 2019; 28:1363-1370. [PMID: 30972568 DOI: 10.1007/s00586-019-05971-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/19/2019] [Accepted: 04/05/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Postoperative standing radiographs are usually performed before hospital discharge after AIS fusion. However, patients are often still painful and have not recovered yet their physiological balance. The aim of this study was therefore to evaluate the relevance of such early radiographs and more specifically investigate whether postoperative alignment could be analyzed. METHODS All consecutive AIS patients operated between January 2015 and December 2015 were included. All patients underwent biplanar stereoradiographs before hospital discharge, at 4 months postoperative and at last follow-up. Fifteen parameters (eight coronal and seven sagittal), reflecting correction and spinal alignment were measured and compared. The incidence of implant misplacement, requiring or not surgical revision, was recorded. RESULTS In total, 100 patients were included. A significant difference was found for 12 out of the 15 (80%) parameters between the first erect radiograph and the 4-month follow-up visit, including the CVA and the SVA, which are commonly used to assess postoperative alignment. Clavicle, UIV and LIV tilts also decreased significantly at 4 months postoperative. In opposition, no significant change occurred for the same parameters between the 4-month visit and latest follow-up. In nine patients, a pedicle screw was considered misplaced on the first radiograph, but all patients remained asymptomatic and no revision was performed. CONCLUSION There is no need for additional immediate postoperative radiographs in AIS, if an intraoperative radiograph has already been taken. This finding could help reducing radiation exposure in immature patients and should be further studied in other etiologies. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- S Tournemine
- Department of Pediatric Orthopaedics, Robert Debré Hospital, AP-HP, Paris Diderot University, 48 Boulevard Serurier, 75019, Paris, France
| | - A Angelliaume
- Department of Pediatric Orthopaedics, Robert Debré Hospital, AP-HP, Paris Diderot University, 48 Boulevard Serurier, 75019, Paris, France
| | - A L Simon
- Department of Pediatric Orthopaedics, Robert Debré Hospital, AP-HP, Paris Diderot University, 48 Boulevard Serurier, 75019, Paris, France
| | - B Ilharreborde
- Department of Pediatric Orthopaedics, Robert Debré Hospital, AP-HP, Paris Diderot University, 48 Boulevard Serurier, 75019, Paris, France.
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29
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Roche B, Simon AL, Guilmin-Crépon S, Boizeau P, Andriss B, Alberti C, Presedo A, Ilharreborde B, Husson I. Test-retest reliability of an instrumented electronic walkway system (GAITRite) for the measurement of spatio-temporal gait parameters in young patients with Friedreich's ataxia. Gait Posture 2018; 66:45-50. [PMID: 30145474 DOI: 10.1016/j.gaitpost.2018.08.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/13/2018] [Accepted: 08/19/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Friedreich ataxia (FRDA) affects the spatio-temporal parameters (STP) of gait. To our knowledge, proper tools to measure the variability of ataxic gait have not been validated yet. The aims of the present study were: (1) to measure the reproducibility of STP and gait scores in young patients with FRDA and (2) to describe the characteristics of gait parameters in this population. METHODS Thirty-six patients (18 males, 18 females) with diagnosis of FRDA (mean age 16.4 ± 4.5 years) were asked to walk barefoot at a self-selected pace along the pressure sensitive walkway (GAITRite®). Three trials were recorded for each patient and repeated 48 h later. Collected data was put into statistical analysis tests to determine reliability and variability of STPs and two other gait scores: The Functional Ambulation Performance score (FAP) and the Gait Variability Index (GVI). RESULTS All STPs showed strong or very strong reliability (ICC > 0.7) and a low variability. The two parameters showing the lowest reliability (0.71 and 0.74) were the base of support and the foot progression angle. The FAP score and the GVI showed strong reliability (ICC > 0.8). CONCLUSIONS The GAITRite system allows feasible and reliable measurements of gait parameters in young patients with FRDA. Lower reliability found for the weakest parameters was attributed to the software automatic errors and the ankle laxity noted in every patient.
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Affiliation(s)
- Bastien Roche
- Assistance Publique des Hôpitaux de Paris (AP-HP), Robert Debré University Hospital, Gait and Motion Analysis Laboratory, France.
| | - Anne-Laure Simon
- Assistance Publique des Hôpitaux de Paris (AP-HP), Robert Debré University Hospital, Gait and Motion Analysis Laboratory, France; AP-HP, Robert Debré University Hospital, Pediatric Orthopaedic Surgery Department, France
| | - Sophie Guilmin-Crépon
- AP-HP, Robert Debré University Hospital, Clinical Epidemiology Department, France; INSERM UMR-S 1123, ECEVE and CIC-EC 1426, Robert Debré University Hospital, France
| | - Priscilla Boizeau
- AP-HP, Robert Debré University Hospital, Clinical Epidemiology Department, France
| | - Béatrice Andriss
- AP-HP, Robert Debré University Hospital, Clinical Epidemiology Department, France
| | - Corinne Alberti
- AP-HP, Robert Debré University Hospital, Clinical Epidemiology Department, France; INSERM UMR-S 1123, ECEVE and CIC-EC 1426, Robert Debré University Hospital, France
| | - Ana Presedo
- AP-HP, Robert Debré University Hospital, Pediatric Orthopaedic Surgery Department, France
| | - Brice Ilharreborde
- AP-HP, Robert Debré University Hospital, Pediatric Orthopaedic Surgery Department, France
| | - Isabelle Husson
- AP-HP, Robert Debré University Hospital, Physical Rehabilitation Department, France; INSERM UMR-S 1141, Robert Debré University Hospital, France
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30
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Mallet C, Caseris M, Doit C, Simon AL, Michelet D, Madre C, Mazda K, Bonacorsi S, Ilharreborde B. Does Staphylococcus aureus nasal decontamination affect the rate of early surgical site infection in adolescent idiopathic scoliosis surgery? Eur Spine J 2018; 27:2543-2549. [PMID: 30145656 DOI: 10.1007/s00586-018-5744-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 07/30/2018] [Accepted: 08/17/2018] [Indexed: 01/28/2023]
Abstract
PURPOSE Surgical site infection (SSI) is a main complication after adolescent idiopathic scoliosis (AIS) surgery. Nasal colonization with S. aureus is a known risk factor for developing nosocomial infections in cardiac surgery. However, the risk in orthopedic surgery remains unclear, especially in spine surgery. This study aims to report the efficacy of a preoperative nasal decontamination program in S. aureus carriers on the incidence of early SSI after AIS posterior surgery. METHODS Between January 2014 and July 2017, all AIS patients were screened preoperatively with nasal swabs and decontaminated if positive 5 days before surgery. Early SSI was identified, and microorganisms findings were analyzed within nasal carriage and compared to a previous series published before the decontamination program (2007-2011). RESULTS Among the 331 AIS posterior fusion performed during the study period, incidence of positive nasal swab was 23% (n = 75). Those were preoperatively decontaminated. In comparison with the period before the nasal decontamination program, incidence of S. aureus early SSI significantly decreased from 5.1 to 1.3%, p < 0.05. None of those S. aureus decontaminated patients had an early S. aureus SSI. In all cases of S. aureus infections, S. aureus nasal screening was negative with a mean delay of 315 days (± 115) before surgery, which was significantly different from the global cohort (104 days ± 67, p < 0.05). CONCLUSIONS Preoperative S. aureus nasal decontamination was associated with a significant decrease in S. aureus SSI. Optimal delay of nasal screening needs to be optimized in order to diagnose intermittent S. aureus carriers. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Cindy Mallet
- Pediatric Orthopedic Department, Robert Debré University Hospital, Paris Diderot University, 48 Boulevard Sérurier, 75019, Paris, France.
| | - Marion Caseris
- Pediatric Infectious Disease Department, Robert Debré University Hospital, Paris Diderot University, Paris, France
| | - Catherine Doit
- Microbiology Department, Robert Debré University Hospital, Paris Diderot University, Paris, France
| | - Anne-Laure Simon
- Pediatric Orthopedic Department, Robert Debré University Hospital, Paris Diderot University, 48 Boulevard Sérurier, 75019, Paris, France
| | - Daphné Michelet
- Anesthesiology and Intensive Care Department, Robert Debré University Hospital, Paris Diderot University, Paris, France
| | - Chrystel Madre
- Pediatric Orthopedic Department, Robert Debré University Hospital, Paris Diderot University, 48 Boulevard Sérurier, 75019, Paris, France
| | - Keyvan Mazda
- Pediatric Orthopedic Department, Robert Debré University Hospital, Paris Diderot University, 48 Boulevard Sérurier, 75019, Paris, France
| | - Stéphane Bonacorsi
- Microbiology Department, Robert Debré University Hospital, Paris Diderot University, Paris, France
| | - Brice Ilharreborde
- Pediatric Orthopedic Department, Robert Debré University Hospital, Paris Diderot University, 48 Boulevard Sérurier, 75019, Paris, France
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31
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Ferrero E, Mazda K, Simon AL, Ilharreborde B. Preliminary experience with SpineEOS, a new software for 3D planning in AIS surgery. Eur Spine J 2018; 27:2165-2174. [PMID: 29693200 DOI: 10.1007/s00586-018-5591-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 01/09/2018] [Accepted: 04/07/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Preoperative planning of scoliosis surgery is essential in the effective treatment of spine pathology. Thus, precontoured rods have been recently developed to avoid iatrogenic sagittal misalignment and rod breakage. Some specific issues exist in adolescent idiopathic scoliosis (AIS), such as a less distal lower instrumented level, a great variability in the location of inflection point (transition from lumbar lordosis to thoracic kyphosis), and sagittal correction is limited by both bone-implant interface. Since 2007, stereoradiographic imaging system is used and allows for 3D reconstructions. Therefore, a software was developed to perform preoperative 3D surgical planning and to provide rod's shape and length. The goal of this preliminary study was to assess the feasibility, reliability, and the clinical relevance of this new software. METHODS Retrospective study on 47 AIS patients operated with the same surgical technique: posteromedial translation through posterior approach with lumbar screws and thoracic sublaminar bands. Pre- and postoperatively, 3D reconstructions were performed on stereoradiographic images (EOS system, Paris, France) and compared. Then, the software was used to plan the surgical correction and determine rod's shape and length. Simulated spine and rods were compared to postoperative real 3D reconstructions. 3D reconstructions and planning were performed by an independent observer. RESULTS 3D simulations were performed on the 47 patients. No difference was found between the simulated model and the postoperative 3D reconstructions in terms of sagittal parameters. Postoperatively, 21% of LL were not within reference values. Postoperative SVA was 20 mm anterior in 2/3 of the cases. Postoperative rods were significantly longer than precontoured rods planned with the software (mean 10 mm). Inflection points were different on the rods used and the planned rods (2.3 levels on average). CONCLUSION In this preliminary study, the software based on 3D stereoradiography low-dose system used to plan AIS surgery seems reliable for preoperative planning and precontoured rods. It is an interesting tool to improve surgeons' practice, since 3D planning is expected to reduce complications such as iatrogenic malalignment and to help for a better understanding of the complications, choosing the location of the transitional vertebra. However, further work is needed to improve thoracic kyphosis planning. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Emmanuelle Ferrero
- Department of Pediatric Orthopaedics, Robert Debré Hospital, Paris 7 University, AP-HP, 48 boulevard Sérurier, 75019, Paris, France.
| | - Keyvan Mazda
- Department of Pediatric Orthopaedics, Robert Debré Hospital, Paris 7 University, AP-HP, 48 boulevard Sérurier, 75019, Paris, France
| | - Anne-Laure Simon
- Department of Pediatric Orthopaedics, Robert Debré Hospital, Paris 7 University, AP-HP, 48 boulevard Sérurier, 75019, Paris, France
| | - Brice Ilharreborde
- Department of Pediatric Orthopaedics, Robert Debré Hospital, Paris 7 University, AP-HP, 48 boulevard Sérurier, 75019, Paris, France
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Czerwinska I, Kulesza A, Choi C, Chirot F, Simon AL, Far J, Kune C, de Pauw E, Dugourd P. Supramolecular influence on cis-trans isomerization probed by ion mobility spectrometry. Phys Chem Chem Phys 2018; 18:32331-32336. [PMID: 27853790 DOI: 10.1039/c6cp06168k] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
We used tandem ion mobility spectrometry measurements to investigate how the photo-isomerization of a chromophore (a methylpyridinium derivative) is affected by the complexation with a crown ether. A dramatic blue-shift of the photo-isomerization spectrum was observed upon complexation, which could be well reproduced by ab initio calculations. Our results support that the observed changes in the photo-physical properties of the chromophore originate from the charge-solvation of its pyridinium moiety by the host cage.
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Affiliation(s)
- Izabella Czerwinska
- Mass Spectrometry Laboratory, University of Liège, Quartier Agora, Allée du Six Aout 11, B-4000 Liège, Belgium
| | - Alexander Kulesza
- Univ Lyon, Université Claude Bernard Lyon 1, CNRS, Institut Lumière Matière, F-69622, Villeurbanne, France
| | - Changmin Choi
- Univ Lyon, Université Claude Bernard Lyon 1, CNRS, Institut Lumière Matière, F-69622, Villeurbanne, France
| | - Fabien Chirot
- Univ Lyon, Université Claude Bernard Lyon 1, Ens de Lyon, CNRS, Institut des Sciences Analytiques, UMR 5280, 5 rue de la Doua, F-69100, Villeurbanne, France.
| | - Anne-Laure Simon
- Univ Lyon, Université Claude Bernard Lyon 1, CNRS, Institut Lumière Matière, F-69622, Villeurbanne, France
| | - Johann Far
- Mass Spectrometry Laboratory, University of Liège, Quartier Agora, Allée du Six Aout 11, B-4000 Liège, Belgium
| | | | - Edwin de Pauw
- Mass Spectrometry Laboratory, University of Liège, Quartier Agora, Allée du Six Aout 11, B-4000 Liège, Belgium
| | - Philippe Dugourd
- Univ Lyon, Université Claude Bernard Lyon 1, CNRS, Institut Lumière Matière, F-69622, Villeurbanne, France
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Droz N, Enouf V, Bidet P, Mohamed D, Behillil S, Simon AL, Bachy M, Caseris M, Bonacorsi S, Basmaci R. Temporal Association Between Rhinovirus Activity and Kingella kingae Osteoarticular Infections. J Pediatr 2018; 192:234-239.e2. [PMID: 29246347 DOI: 10.1016/j.jpeds.2017.09.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/21/2017] [Accepted: 09/21/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To determine whether the seasonal distribution of Kingella kingae osteoarticular infections is similar to that of common respiratory viruses. STUDY DESIGN Between October 2009 and September 2016, we extracted the results of K kingae-specific real-time polymerase chain reaction analyses performed for bone or joint specimens in patients from 2 pediatric tertiary care centers in Paris. We used data of respiratory virus detection from the Réseau National des Laboratoires network with coordination with the National Influenza Center of France. The Spearman rank correlation was used to assess a correlation between weekly distributions, with P < .05 denoting a significant correlation. RESULTS During the 7-year study period, 322 children were diagnosed with K kingae osteoarticular infection, and 317 testing episodes were K kingae-negative. We observed high activity for both K kingae osteoarticular infection and human rhinovirus (HRV) during the fall (98 [30.4%] and 2401 [39.1%] cases, respectively) and low activity during summer (59 [18.3%] and 681 [11.1%] cases, respectively). Weekly distributions of K kingae osteoarticular infection and rhinovirus activity were significantly correlated (r = 0.30; P = .03). In contrast, no significant correlation was found between the weekly distribution of K kingae osteoarticular infection and other respiratory viruses (r = -0.17, P = .34 compared with respiratory syncytial virus; r = -0.13, P = .34 compared with influenza virus; and r = -0.22, P = .11 compared with metapneumovirus). CONCLUSION A significant temporal association was observed between HRV circulation and K kingae osteoarticular infection, strengthening the hypothesis of a role of viral infections in the pathophysiology of K kingae invasive infection.
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Affiliation(s)
- Nina Droz
- Pediatric-Emergency Department, Louis-Mourier Hospital, AP-HP, Colombes, France
| | - Vincent Enouf
- Coordinating Center of the National Reference Center for Influenza Viruses, Institut Pasteur, UMR 3569 CNRS, Paris Diderot-Paris 7 University, Sorbonne Paris Cité
| | - Philippe Bidet
- Department of Microbiology, Robert Debré Hospital, AP-HP, Associated-National Reference Center for Escherichia Coli, Paris, France; IAME, UMR 1137, INSERM, Paris Diderot University, Sorbonne Paris Cité
| | - Damir Mohamed
- Unit of Clinical Epidemiology, Robert Debré Hospital, AP-HP, Paris, France; Inserm, CIC-EC 1426, Paris, France
| | - Sylvie Behillil
- Coordinating Center of the National Reference Center for Influenza Viruses, Institut Pasteur, UMR 3569 CNRS, Paris Diderot-Paris 7 University, Sorbonne Paris Cité
| | - Anne-Laure Simon
- Department of Pediatric Orthopedic Surgery, Robert Debré Hospital, AP-HP, Paris, France
| | - Manon Bachy
- Department of Pediatric Orthopedic Surgery, Armand Trousseau Hospital, APHP, Pierre et Marie Curie Paris 6 University, Paris, France
| | - Marion Caseris
- Department of Pediatric Infectious Diseases, Robert Debré Hospital, AP-HP, Paris, France
| | - Stéphane Bonacorsi
- Department of Microbiology, Robert Debré Hospital, AP-HP, Associated-National Reference Center for Escherichia Coli, Paris, France; IAME, UMR 1137, INSERM, Paris Diderot University, Sorbonne Paris Cité
| | - Romain Basmaci
- Pediatric-Emergency Department, Louis-Mourier Hospital, AP-HP, Colombes, France; IAME, UMR 1137, INSERM, Paris Diderot University, Sorbonne Paris Cité.
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Martin K, Iyengar S, Kalyan A, Lan C, Simon AL, Stosic M, Kobara K, Ravi H, Truong T, Ryan A, Demko ZP, Benn P. Clinical experience with a single-nucleotide polymorphism-based non-invasive prenatal test for five clinically significant microdeletions. Clin Genet 2017; 93:293-300. [PMID: 28696552 DOI: 10.1111/cge.13098] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 06/30/2017] [Indexed: 01/06/2023]
Abstract
Single-nucleotide polymorphism (SNP)-based non-invasive prenatal testing (NIPT) can currently predict a subset of submicroscopic abnormalities associated with severe clinical manifestations. We retrospectively analyzed the performance of SNP-based NIPT in 80 449 referrals for 22q11.2 deletion syndrome and 42 326 referrals for 1p36, cri-du-chat, Prader-Willi, and Angelman microdeletion syndromes over a 1-year period, and compared the original screening protocol with a revision that reflexively sequenced high-risk calls at a higher depth of read. The prevalence of these microdeletion syndromes was also estimated in the referral population. The positive predictive value of the original test was 15.7% for 22q11.2 deletion syndrome, and 5.2% for the other 4 disorders combined. With the revised protocol, these values increased to 44.2% for 22q11.2 and 31.7% for the others. The 0.33% false-positive rate (FPR) for 22q11.2 deletion syndrome decreased to 0.07% with the revised protocol. Similarly, the FPR for the other 4 disorders combined decreased from 0.56% to 0.07%. Minimal prevalences were estimated to be 1 in 1255 for 22q11.2 deletion syndrome and 1 in 1464 for 1p36, cri-du-chat, and Angelman syndromes combined. Our results show that these microdeletions are relatively common in the referral population, and that the performance of SNP-based NIPT is improved with high-depth resequencing.
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Affiliation(s)
- K Martin
- Natera, Inc., San Carlos, California
| | - S Iyengar
- Natera, Inc., San Carlos, California
| | - A Kalyan
- Natera, Inc., San Carlos, California
| | - C Lan
- Natera, Inc., San Carlos, California
| | - A L Simon
- Natera, Inc., San Carlos, California
| | - M Stosic
- Natera, Inc., San Carlos, California
| | - K Kobara
- Natera, Inc., San Carlos, California
| | - H Ravi
- Natera, Inc., San Carlos, California
| | - T Truong
- Natera, Inc., San Carlos, California
| | - A Ryan
- Natera, Inc., San Carlos, California
| | - Z P Demko
- Natera, Inc., San Carlos, California
| | - P Benn
- Department of Genetics and Genome Sciences, University of Connecticut Health Center, Farmington, Connecticut
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35
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Simon AL, Lugade V, Bernhardt K, Larson AN, Kaufman K. Assessment of stability during gait in patients with spinal deformity-A preliminary analysis using the dynamic stability margin. Gait Posture 2017; 55:37-42. [PMID: 28411443 DOI: 10.1016/j.gaitpost.2017.03.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 03/29/2017] [Accepted: 03/31/2017] [Indexed: 02/02/2023]
Abstract
Daily living activities are dynamic, requiring spinal motion through space. Current assessment of spinal deformities is based on static measurements from full-spine standing radiographs. Tools to assess dynamic stability during gait might be useful to enhance the standard evaluation. The aim of this study was to evaluate gait dynamic imbalance in patients with spinal deformity using the dynamic stability margin (DSM). Twelve normal subjects and 17 patients with spinal deformity were prospectively recruited. A kinematic 3D gait analysis was performed for the control group (CG) and the spinal deformity group (SDG). The DSM (distance between the extrapolated center of mass and the base of support) and time-distance parameters were calculated for the right and left side during gait. The relationship between DSM and step length was assessed using three variables: gait stability, symmetry, and consistency. Variables' accuracy was validated by a discriminant analysis. Patients with spinal deformity exhibited gait instability according to the DSM (0.25m versus 0.31m) with decreased velocity (1.1ms-1 versus 1.3ms-1) and decreased step length (0.32m versus 0.38m). According to the discriminant analysis, gait stability was the more accurate variable (area under the curve AUC=0.98) followed by gait symmetry and consistency. However, gait consistency showed 100% of specificity, sensitivity, and accuracy of precision. The DSM showed that patients with spinal malalignment exhibit decreased gait stability, symmetry, and consistency besides gait time-distance parameter changes. Additional work is required to determine how to apply the DSM for preoperative and postoperative spinal deformity management.
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Affiliation(s)
- Anne-Laure Simon
- Motion Analysis Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Biomechanics Laboratory, Ecole Nationale Supérieure des Arts et Métiers-Paris Tech, 151 Bd de l'Hôpital, 75013 Paris, France
| | - Vipul Lugade
- Motion Analysis Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Whitaker International Program, Department of Physical Therapy, Chiang Mai University, 110 Intawaroroj Rd, Sripoom, Chiang Mai 50200, Thailand
| | - Kathie Bernhardt
- Motion Analysis Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - A Noelle Larson
- Pediatric Orthopaedics Department, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Kenton Kaufman
- Motion Analysis Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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36
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Czerwinska I, Kulesza A, Choi C, Chirot F, Simon AL, Far J, Kune C, de Pauw E, Dugourd P. Correction: Supramolecular influence on cis–trans isomerization probed by ion mobility spectrometry. Phys Chem Chem Phys 2017; 19:15570. [DOI: 10.1039/c7cp90113e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Correction for ‘Supramolecular influence on cis–trans isomerization probed by ion mobility spectrometry’ by Izabella Czerwinska et al., Phys. Chem. Chem. Phys., 2016, 18, 32331–32336.
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Affiliation(s)
- Izabella Czerwinska
- Mass Spectrometry Laboratory
- University of Liège
- Quartier Agora
- B-4000 Liège
- Belgium
| | - Alexander Kulesza
- Univ Lyon
- Université Claude Bernard Lyon 1
- CNRS
- Institut Lumière Matière
- Villeurbanne
| | - Changmin Choi
- Univ Lyon
- Université Claude Bernard Lyon 1
- CNRS
- Institut Lumière Matière
- Villeurbanne
| | - Fabien Chirot
- Univ Lyon
- Université Claude Bernard Lyon 1
- Ens de Lyon
- CNRS
- Institut des Sciences Analytiques
| | - Anne-Laure Simon
- Univ Lyon
- Université Claude Bernard Lyon 1
- CNRS
- Institut Lumière Matière
- Villeurbanne
| | - Johann Far
- Mass Spectrometry Laboratory
- University of Liège
- Quartier Agora
- B-4000 Liège
- Belgium
| | - Christopher Kune
- Mass Spectrometry Laboratory
- University of Liège
- Quartier Agora
- B-4000 Liège
- Belgium
| | - Edwin de Pauw
- Mass Spectrometry Laboratory
- University of Liège
- Quartier Agora
- B-4000 Liège
- Belgium
| | - Philippe Dugourd
- Univ Lyon
- Université Claude Bernard Lyon 1
- CNRS
- Institut Lumière Matière
- Villeurbanne
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Mas V, Ilharreborde B, Mallet C, Mazda K, Simon AL, Jehanno P. Video-assisted functional assessment of index pollicisation in congenital anomalies. J Child Orthop 2016; 10:301-6. [PMID: 27351184 PMCID: PMC4940251 DOI: 10.1007/s11832-016-0756-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 06/21/2016] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Functional results of index pollicisation are usually assessed by the clinical score of Percival. This score is based on elementary hand movements and does not reflect the function of the neo thumb in daily life activities. The aim of this study was to develop a new video-assisted scoring system based on daily life activities to assess index pollicisation functional outcomes. METHODS Twenty-two consecutive children, operated between 1998 and 2012, were examined with a mean of 77 months after surgery. The mean age at surgery was 34 months. Post-operative results were evaluated by a new video-assisted 14-point scoring system consisting of seven basic tasks that are frequently used in daily activities. The series of tasks was performed both on the request of the examiner and in real-life conditions with the use of a hidden camera. Each video recording was examined by three different examiners. Each examiner rated the video recordings three times, with an interval of one week between examinations. Inter- and intra-observer agreements were calculated. RESULTS Inter- and intra-observer agreements were excellent both on request (κ = 0.87 [0.84-0.97] for inter-observer agreement and 0.92 [0.82-0.98] for intra-observer agreement) and on hidden camera (κ = 0.83 [0.78-0.91] for inter-observer agreement and 0.89 [0.83-0.96] for intra-observer agreement). The results were significantly better on request than on hidden camera (p = 0.045). The correlation between the video-assisted scoring system and the Percival score was poor. CONCLUSION The video-assisted scoring system is a reliable tool to assess index pollicisation functional outcomes. The scoring system on hidden camera is more representative of the neo thumb use in daily life complex movements. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Virginie Mas
- Paediatric Orthopaedic Department, Robert Debré Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris Diderot University, 48 Bd. Sérurier, 75019 Paris, France
| | - Brice Ilharreborde
- Paediatric Orthopaedic Department, Robert Debré Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris Diderot University, 48 Bd. Sérurier, 75019 Paris, France
| | - Cindy Mallet
- Paediatric Orthopaedic Department, Robert Debré Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris Diderot University, 48 Bd. Sérurier, 75019 Paris, France
| | - Keyvan Mazda
- Paediatric Orthopaedic Department, Robert Debré Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris Diderot University, 48 Bd. Sérurier, 75019 Paris, France
| | - Anne-Laure Simon
- Paediatric Orthopaedic Department, Robert Debré Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris Diderot University, 48 Bd. Sérurier, 75019 Paris, France
| | - Pascal Jehanno
- Paediatric Orthopaedic Department, Robert Debré Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris Diderot University, 48 Bd. Sérurier, 75019 Paris, France
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Ferrero E, Simon AL, Magrino B, Ould-Slimane M, Guigui P. Double-level degenerative spondylolisthesis: what is different in the sagittal plane? Eur Spine J 2016; 25:2546-52. [DOI: 10.1007/s00586-016-4384-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 01/08/2016] [Accepted: 01/10/2016] [Indexed: 10/22/2022]
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Choi CM, Simon AL, Chirot F, Kulesza A, Knight G, Daly S, MacAleese L, Antoine R, Dugourd P. Charge, Color, and Conformation: Spectroscopy on Isomer-Selected Peptide Ions. J Phys Chem B 2016; 120:709-14. [PMID: 26756462 PMCID: PMC4819951 DOI: 10.1021/acs.jpcb.5b11919] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
![]()
Monitoring the chromism induced by
intramolecular hydrogen and
charge transfers within proteins as well as the isomerization of both
protein and cofactor is essential not only to understand photoactive
signaling pathways but also to design targeted opto-switchable proteins.
We used a dual-ion mobility drift tube coupled to a tunable picosecond
laser to explore the optical and structural properties of a peptide
chain bound to a chromophore—a prototype system allowing for
a proton transfer coupled to conformational change. With the support
of molecular dynamics and DFT calculations, we show how proton transfer
between the peptide and its cofactor can dramatically modify the optical
properties of the system and demonstrate that these changes can be
triggered by collisional activation in the gas phase.
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Affiliation(s)
- Chang Min Choi
- Institut Lumière Matière and ‡Institut des Sciences Analytiques, Université Lyon 1-CNRS, Université de Lyon , 69622 Villeurbanne Cedex, France
| | - Anne-Laure Simon
- Institut Lumière Matière and ‡Institut des Sciences Analytiques, Université Lyon 1-CNRS, Université de Lyon , 69622 Villeurbanne Cedex, France
| | - Fabien Chirot
- Institut Lumière Matière and ‡Institut des Sciences Analytiques, Université Lyon 1-CNRS, Université de Lyon , 69622 Villeurbanne Cedex, France
| | - Alexander Kulesza
- Institut Lumière Matière and ‡Institut des Sciences Analytiques, Université Lyon 1-CNRS, Université de Lyon , 69622 Villeurbanne Cedex, France
| | - Geoffrey Knight
- Institut Lumière Matière and ‡Institut des Sciences Analytiques, Université Lyon 1-CNRS, Université de Lyon , 69622 Villeurbanne Cedex, France
| | - Steven Daly
- Institut Lumière Matière and ‡Institut des Sciences Analytiques, Université Lyon 1-CNRS, Université de Lyon , 69622 Villeurbanne Cedex, France
| | - Luke MacAleese
- Institut Lumière Matière and ‡Institut des Sciences Analytiques, Université Lyon 1-CNRS, Université de Lyon , 69622 Villeurbanne Cedex, France
| | - Rodolphe Antoine
- Institut Lumière Matière and ‡Institut des Sciences Analytiques, Université Lyon 1-CNRS, Université de Lyon , 69622 Villeurbanne Cedex, France
| | - Philippe Dugourd
- Institut Lumière Matière and ‡Institut des Sciences Analytiques, Université Lyon 1-CNRS, Université de Lyon , 69622 Villeurbanne Cedex, France
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40
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Kulesza A, Daly S, Choi CM, Simon AL, Chirot F, MacAleese L, Antoine R, Dugourd P. The structure of chromophore-grafted amyloid-β12–28 dimers in the gas-phase: FRET-experiment guided modelling. Phys Chem Chem Phys 2016; 18:9061-9. [DOI: 10.1039/c6cp00263c] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Theoretical modelling, ion mobility spectrometry and action-FRET experiments are combined to an experiment guided approach and used to elucidate the structure of chromophore-grafted amyloid-β12–28 dimers in the gas-phase.
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Affiliation(s)
| | - Steven Daly
- Université de Lyon
- F-69622 Lyon
- France
- Institut Lumière Matière
- UMR5306
| | - Chang Min Choi
- Université de Lyon
- F-69622 Lyon
- France
- Institut Lumière Matière
- UMR5306
| | - Anne-Laure Simon
- Université de Lyon
- F-69622 Lyon
- France
- Institut Lumière Matière
- UMR5306
| | - Fabien Chirot
- Université de Lyon
- F-69622 Lyon
- France
- Institut des Sciences Analytiques
- UMR5280
| | - Luke MacAleese
- Université de Lyon
- F-69622 Lyon
- France
- Institut Lumière Matière
- UMR5306
| | - Rodolphe Antoine
- Université de Lyon
- F-69622 Lyon
- France
- Institut Lumière Matière
- UMR5306
| | - Philippe Dugourd
- Université de Lyon
- F-69622 Lyon
- France
- Institut Lumière Matière
- UMR5306
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41
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Lepere V, Le Barbu-Debus K, Clavaguéra C, Scuderi D, Piani G, Simon AL, Chirot F, MacAleese L, Dugourd P, Zehnacker A. Chirality-dependent structuration of protonated or sodiated polyphenylalanines: IRMPD and ion mobility studies. Phys Chem Chem Phys 2015; 18:1807-17. [PMID: 26679547 DOI: 10.1039/c5cp06768e] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Ion mobility experiments are combined with Infra-Red Multiple Photon Dissociation (IRMPD) spectroscopy and quantum chemical calculations for assessing the role of chirality in the structure of protonated and sodiated di- or tetra-peptides. Sodiated systems show a strong chirality dependence of the competition between Na(+)O and Na(+)π interactions. Chirality effects are more subtle in protonated systems and manifest themselves by differences in the secondary interactions such hydrogen bonds between neutral groups or those involving the aromatic rings.
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Affiliation(s)
- Valeria Lepere
- Institut des Sciences Moléculaires d'Orsay (ISMO), CNRS, Univ. Paris-Sud, Université Paris-Saclay, F-91405 Orsay, France.
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42
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Daly S, Kulesza A, Poussigue F, Simon AL, Choi CM, Knight G, Chirot F, MacAleese L, Antoine R, Dugourd P. Correction: Conformational changes in amyloid-beta (12-28) alloforms studied using action-FRET, IMS and molecular dynamics simulations. Chem Sci 2015; 7:1609-1610. [PMID: 30124673 PMCID: PMC6063148 DOI: 10.1039/c5sc90069g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 11/04/2015] [Indexed: 11/23/2022] Open
Abstract
Correction for ‘Conformational changes in amyloid-beta (12–28) alloforms studied using action-FRET, IMS and molecular dynamics simulations’ by Steven Daly et al., Chem. Sci., 2015, 6, 5040–5047.
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Affiliation(s)
- Steven Daly
- Université de Lyon , F-69622 , Lyon , France . .,CNRS et Université Lyon 1 , UMR5306 , Institut Lumière Matière , France
| | - Alexander Kulesza
- Université de Lyon , F-69622 , Lyon , France . .,CNRS et Université Lyon 1 , UMR5306 , Institut Lumière Matière , France
| | - Frederic Poussigue
- Université de Lyon , F-69622 , Lyon , France . .,CNRS et Université Lyon 1 , UMR 5280 , Institut des Sciences Analytiques , France
| | - Anne-Laure Simon
- Université de Lyon , F-69622 , Lyon , France . .,CNRS et Université Lyon 1 , UMR5306 , Institut Lumière Matière , France
| | - Chang Min Choi
- Université de Lyon , F-69622 , Lyon , France . .,CNRS et Université Lyon 1 , UMR5306 , Institut Lumière Matière , France
| | - Geoffrey Knight
- Université de Lyon , F-69622 , Lyon , France . .,CNRS et Université Lyon 1 , UMR5306 , Institut Lumière Matière , France
| | - Fabien Chirot
- Université de Lyon , F-69622 , Lyon , France . .,CNRS et Université Lyon 1 , UMR 5280 , Institut des Sciences Analytiques , France
| | - Luke MacAleese
- Université de Lyon , F-69622 , Lyon , France . .,CNRS et Université Lyon 1 , UMR5306 , Institut Lumière Matière , France
| | - Rodolphe Antoine
- Université de Lyon , F-69622 , Lyon , France . .,CNRS et Université Lyon 1 , UMR5306 , Institut Lumière Matière , France
| | - Philippe Dugourd
- Université de Lyon , F-69622 , Lyon , France . .,CNRS et Université Lyon 1 , UMR5306 , Institut Lumière Matière , France
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43
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Simon AL. [Detection and surveillance of idiopathic scoliosis]. Rev Prat 2015; 65:1155-1158. [PMID: 30512501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Detection and surveillance of idiopathic scoliosis. Spinal deformities are frequent in children. Detection on physical examination must be systematically performed especially in pre-puberty period because of the potential risk of progression. The main spinal pathology remains scoliosis, which affects 2 to 3% of the population. The presence of a rib hump is pathognomonic for the diagnosis of scoliosis. The diagnosis is confirmed by full-spine radiographs, on which a Cobb angle is > 10° and is associated to a vertebral rotation. Idiopathic scoliosis is the most frequent aetiology (80 to 90% of the cases). However, a secondary aetiology must be systematically evocated. The follow-up depends on the age of the patient and the severity of the deformity. A clinical and a radiological follow-up must be performed every 3 to 6 months and must be particularly close in younger patients.
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Affiliation(s)
- Anne-Laure Simon
- Service de chirurgie orthopédique pédiatrique, CHU Robert-Debré, AP-HP, université Paris-Diderot, Paris, France
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44
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Simon AL, Su B, Demko Z, Rabinowitz M, Harmon ER, Gross SJ. Detection of complete molar pregnancy by single-nucleotide polymorphism-based non-invasive prenatal testing. Ultrasound Obstet Gynecol 2015; 46:506-507. [PMID: 25810270 DOI: 10.1002/uog.14854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 03/05/2015] [Accepted: 03/17/2015] [Indexed: 06/04/2023]
Affiliation(s)
- A L Simon
- Natera, Inc., 201 Industrial Road, Suite 410, San Carlos, CA, 94070, USA
| | - B Su
- Natera, Inc., 201 Industrial Road, Suite 410, San Carlos, CA, 94070, USA
| | - Z Demko
- Natera, Inc., 201 Industrial Road, Suite 410, San Carlos, CA, 94070, USA
| | - M Rabinowitz
- Natera, Inc., 201 Industrial Road, Suite 410, San Carlos, CA, 94070, USA
| | | | - S J Gross
- Natera, Inc., 201 Industrial Road, Suite 410, San Carlos, CA, 94070, USA
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45
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Simon AL, Chirot F, Choi CM, Clavier C, Barbaire M, Maurelli J, Dagany X, MacAleese L, Dugourd P. Tandem ion mobility spectrometry coupled to laser excitation. Rev Sci Instrum 2015; 86:094101. [PMID: 26429458 DOI: 10.1063/1.4930604] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
This manuscript describes a new experimental setup that allows to perform tandem ion mobility spectrometry (IMS) measurements and which is coupled to a high resolution time-of-flight mass spectrometer. It consists of two 79 cm long drift tubes connected by a dual ion funnel assembly. The setup was built to permit laser irradiation of the ions in the transfer region between the two drift tubes. This geometry allows selecting ions according to their ion mobility in the first drift tube, to irradiate selected ions, and examine the ion mobility of the product ions in the second drift tube. Activation by collision is possible in the same region (between the two tubes) and between the second tube and the time-of-flight. IMS-IMS experiments on Ubiquitin are reported. We selected a given isomer of charge state +7 and explored its structural rearrangement following collisional activation between the two drift tubes. An example of IMS-laser-IMS experiment is reported on eosin Y, where laser irradiation was used to produce radical ions by electron photodetachment starting from doubly deprotonated species. This allowed measuring the collision cross section of the radical photo-product, which cannot be directly produced with an electrospray source.
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Affiliation(s)
- Anne-Laure Simon
- Institut Lumière Matière, Université de Lyon, Université Lyon 1-CNRS, 69622 Villeurbanne cedex, France
| | - Fabien Chirot
- Institut des Sciences Analytiques, Université de Lyon, Université Lyon 1-CNRS, 69622 Villeurbanne cedex, France
| | - Chang Min Choi
- Institut Lumière Matière, Université de Lyon, Université Lyon 1-CNRS, 69622 Villeurbanne cedex, France
| | - Christian Clavier
- Institut Lumière Matière, Université de Lyon, Université Lyon 1-CNRS, 69622 Villeurbanne cedex, France
| | - Marc Barbaire
- Institut Lumière Matière, Université de Lyon, Université Lyon 1-CNRS, 69622 Villeurbanne cedex, France
| | - Jacques Maurelli
- Institut Lumière Matière, Université de Lyon, Université Lyon 1-CNRS, 69622 Villeurbanne cedex, France
| | - Xavier Dagany
- Institut Lumière Matière, Université de Lyon, Université Lyon 1-CNRS, 69622 Villeurbanne cedex, France
| | - Luke MacAleese
- Institut Lumière Matière, Université de Lyon, Université Lyon 1-CNRS, 69622 Villeurbanne cedex, France
| | - Philippe Dugourd
- Institut Lumière Matière, Université de Lyon, Université Lyon 1-CNRS, 69622 Villeurbanne cedex, France
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46
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Daly S, Kulesza A, Poussigue F, Simon AL, Choi CM, Knight G, Chirot F, MacAleese L, Antoine R, Dugourd P. Conformational changes in amyloid-beta (12-28) alloforms studied using action-FRET, IMS and molecular dynamics simulations. Chem Sci 2015; 6:5040-5047. [PMID: 30155007 PMCID: PMC6088554 DOI: 10.1039/c5sc01463h] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 06/17/2015] [Indexed: 01/21/2023] Open
Abstract
Small oligomers of the amyloid beta protein (Aβ) have been implicated as the neurotoxic agent leading to Alzheimer's disease, and in particular mutations in the hydrophobic core region comprising amino acids L17 to A21 have a large influence on the propensity for aggregate formation. It has been shown that the F19P alloform of Aβ forms small aggregates, but does not proceed to form large fibrils and plaques. In order to understand the origin of this behavior, the gas phase conformations for the different charge states of the wild-type 12-28 fragment of the amyloid beta and its F19P alloform were studied by a combination of action-FRET, ion-mobility spectrometry (IMS) and molecular dynamics simulations. Comparison of the experimental and theoretical action-FRET efficiencies and collision cross sections allowed the determination of the lowest energy conformational family for each alloform and charge state. For both alloforms, it was found that there is a change from globular to helical structure between the 3+ and 4+ charge states. Additional protonation to give 5+ and 6+ charge states caused unfolding of this helical motif, with the wild alloform showing β-turn like motifs and the F19P alloform random coil motifs. The presence of the helical to β-turn structural transition in the wild, but not the F19P, alloform may help to elucidate the origin of the large difference in aggregation behavior of the two alloforms.
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Affiliation(s)
- Steven Daly
- Université de Lyon , F-69622 , Lyon , France
- CNRS et Université Lyon 1 , UMR5306 , Institut Lumière Matière , France .
| | - Alexander Kulesza
- Université de Lyon , F-69622 , Lyon , France
- CNRS et Université Lyon 1 , UMR5306 , Institut Lumière Matière , France .
| | - Frederic Poussigue
- Université de Lyon , F-69622 , Lyon , France
- CNRS et Université Lyon 1 , UMR 5280 , Institut des Sciences Analytiques , France
| | - Anne-Laure Simon
- Université de Lyon , F-69622 , Lyon , France
- CNRS et Université Lyon 1 , UMR5306 , Institut Lumière Matière , France .
| | - Chang Min Choi
- Université de Lyon , F-69622 , Lyon , France
- CNRS et Université Lyon 1 , UMR5306 , Institut Lumière Matière , France .
| | - Geoffrey Knight
- Université de Lyon , F-69622 , Lyon , France
- CNRS et Université Lyon 1 , UMR5306 , Institut Lumière Matière , France .
| | - Fabien Chirot
- Université de Lyon , F-69622 , Lyon , France
- CNRS et Université Lyon 1 , UMR 5280 , Institut des Sciences Analytiques , France
| | - Luke MacAleese
- Université de Lyon , F-69622 , Lyon , France
- CNRS et Université Lyon 1 , UMR5306 , Institut Lumière Matière , France .
| | - Rodolphe Antoine
- Université de Lyon , F-69622 , Lyon , France
- CNRS et Université Lyon 1 , UMR5306 , Institut Lumière Matière , France .
| | - Philippe Dugourd
- Université de Lyon , F-69622 , Lyon , France
- CNRS et Université Lyon 1 , UMR5306 , Institut Lumière Matière , France .
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47
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Simon AL, Ilharreborde B, Souchet P, Kaufman KR. Dynamic balance assessment during gait in spinal pathologies - a literature review. Orthop Traumatol Surg Res 2015; 101:235-46. [PMID: 25765946 DOI: 10.1016/j.otsr.2014.11.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 11/28/2014] [Indexed: 02/02/2023]
Abstract
UNLABELLED The role of the spine as a gait stabilizer is essential. Dynamic assessment, while walking, might provide complementary data to improve spinal deformity management. The aim of this paper was to review spine dynamic behavior and the various methods that have been used to assess gait dynamic balance in order to explore the consequences of spinal deformities while walking. A review was performed by obtaining publications from five electronic databases. All papers reporting pathological or non-pathological spine dynamic behavior during gait and dynamic balance assessment methods were included. Sixty articles were selected. Results varied widely according to pathologies, study conditions, and balance assessment techniques. Three methods assessing dynamic stability during gait were identified: local-orbital dynamic stability, tri-axial accelerometry, and dynamic stability margin. Data from conventional gait analysis techniques were established essentially for scoliosis and low back pain, but they do not assess specific consequences on gait dynamic balance. Three techniques investigate gait dynamic balance and have been validated in normal subjects. Further investigations need to be performed for validation in spinal pathologies as well as the value for clinical practice. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- A L Simon
- Motion Analysis Laboratory, Mayo Clinic, Charlton North Building, 200 First Street SW, 55905 Rochester, MN, USA; Pediatric Orthopedic Department, Robert-Debré Hospital, 48, boulevard Serrurier, 75019 Paris, France
| | - B Ilharreborde
- Pediatric Orthopedic Department, Robert-Debré Hospital, 48, boulevard Serrurier, 75019 Paris, France
| | - P Souchet
- Pediatric Orthopedic Department, Robert-Debré Hospital, 48, boulevard Serrurier, 75019 Paris, France
| | - K R Kaufman
- Motion Analysis Laboratory, Mayo Clinic, Charlton North Building, 200 First Street SW, 55905 Rochester, MN, USA.
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48
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Daly S, Poussigue F, Simon AL, MacAleese L, Bertorelle F, Chirot F, Antoine R, Dugourd P. Action-FRET: Probing the Molecular Conformation of Mass-Selected Gas-Phase Peptides with Förster Resonance Energy Transfer Detected by Acceptor-Specific Fragmentation. Anal Chem 2014; 86:8798-804. [DOI: 10.1021/ac502027y] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Steven Daly
- Université de Lyon, F-69622 Lyon, France
- Institut Lumière
Matière, UMR5306, CNRS, Université Lyon 1, 69622 Villeurbanne, France
| | - Frédéric Poussigue
- Université de Lyon, F-69622 Lyon, France
- Institut des Sciences
Analytiques, UMR5280, CNRS, Université Lyon 1, 69100 Villeurbanne, France
| | - Anne-Laure Simon
- Université de Lyon, F-69622 Lyon, France
- Institut Lumière
Matière, UMR5306, CNRS, Université Lyon 1, 69622 Villeurbanne, France
| | - Luke MacAleese
- Université de Lyon, F-69622 Lyon, France
- Institut Lumière
Matière, UMR5306, CNRS, Université Lyon 1, 69622 Villeurbanne, France
| | - Franck Bertorelle
- Université de Lyon, F-69622 Lyon, France
- Institut Lumière
Matière, UMR5306, CNRS, Université Lyon 1, 69622 Villeurbanne, France
| | - Fabien Chirot
- Université de Lyon, F-69622 Lyon, France
- Institut des Sciences
Analytiques, UMR5280, CNRS, Université Lyon 1, 69100 Villeurbanne, France
| | - Rodolphe Antoine
- Université de Lyon, F-69622 Lyon, France
- Institut Lumière
Matière, UMR5306, CNRS, Université Lyon 1, 69622 Villeurbanne, France
| | - Philippe Dugourd
- Université de Lyon, F-69622 Lyon, France
- Institut Lumière
Matière, UMR5306, CNRS, Université Lyon 1, 69622 Villeurbanne, France
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49
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Simon AL, Ilharreborde B, Litzelmann E, Mazda K, Penneçot GF. Eight-Year Natural Course of a Femoral Neck Deformity Secondary to an Osteoid Osteoma Discovered at Fourteen Months of Age: A Case Report. JBJS Case Connect 2013; 3:e119. [PMID: 29252519 DOI: 10.2106/jbjs.cc.m.00108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- A L Simon
- Department of Pediatric Orthopaedic Surgery, Robert Debré Hospital, 48 Boulevard Sérurier 75019 Paris, France.
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Dall'Acqua W, Simon AL, Mulkerrin MG, Carter P. Contribution of domain interface residues to the stability of antibody CH3 domain homodimers. Biochemistry 1998; 37:9266-73. [PMID: 9649307 DOI: 10.1021/bi980270i] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Dimers of CH3 domains from human IgG1 were used to study the effect of mutations constructed at a domain-domain interface upon domain dissociation and unfolding, "complex stability". Alanine replacement mutants were constructed on one side of the interface for each of the sixteen interdomain contact residues by using a single-chain CH3 dimer in which the carboxyl terminus of one domain was joined to the amino terminus of the second domain via a (G4S)4 linker. Single-chain variants were expressed in Escherichia coli grown in a fermentor and recovered in yields of 6-90 mg L-1 by immobilized metal affinity chromatography. Guanidine hydrochloride-induced denaturation was used to follow domain dissociation and unfolding. Surprisingly, the linker did not perturb the complex stability for either the wild type or two destabilizing mutants. The CH3 domain dissociation and unfolding energetics are dominated by six contact residues where corresponding alanine mutations each destabilize the complex by >2.0 kcal mol-1. Five of these residues (T366, L368, F405, Y407, and K409) form a patch at the center of the interface and are located on the two internal antiparallel beta-strands. These energetically key residues are surrounded by 10 residues on the two external beta-strands whose contribution to complex stability is small (three have a Delta DeltaG of 1.1-1.3 kcal mol-1) or very small (seven have a Delta DeltaG of </=0.7 kcal mol-1). Thus, at the center of the CH3 structural interface there is a small "functional interface" of residues that make significant contributions to complex stability.
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Affiliation(s)
- W Dall'Acqua
- Department of Molecular Oncology, Genentech Inc., South San Francisco, California 94080, USA
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